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CARE AND FEEDING OF 
THE INFANT 

GEORGE D. LYMAN, A. B., M. D. 






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CARE AND FEEDING 

of THE INFANT 



CARE 
AND FEEDING 

OF THE 

INFANT 

PRACTICAL ADVICE FOR MOTHERS 

AND NURSES BY 

GEORGE D. LYMAN, A. B., M. D. 

WITH AN INTRODUCTION BY 

RAY LYMAN WILBUR, M. D. 

PRESIDENT 

LELAND STANFORD JR. 

UNIVERSITY 






A. M. ROBERTSON 

SAN FRANCISCO 
M CM XXII 



Copyright, 1922, by 

A. M. ROBERTSON 

San Francisco 






Ricardo J. Orozco : ^Printer 



SEP -7 i322 



)CI.A6&3329 



TO 

D.V.L. 

AND HER DAUGHTERS 

DOROTHY QUINCY 

ELIZABETH ANNE 

AND 

GERTRUDE 



CONTENTS 

Introduction ix 

Rules for the Mother Preceding the 
Baby's Birth 3 

Examination of the New-Born Infant 7 

Physical and Mental Development of 
the Infant 15 

Weight — Measurements — Muscular Develop- 
ment — The Teeth — Special Senses — Sleep, 
Etc. 

Care of the New-Born Babe .... 25 

The Cord — Eyes — Genitalia — Sponging and 
Bathing — The Nursery — The Bed — Baby 
Clothing and Diapers — The Baby Buggy — Kiss- 
ing — Lifting and Carrying — Weighing — The 
Ears — Premature and Weak Babies — Asphyxia 
and Its Treatment. 

Infant Feeding 49 

Breast Feeding and Its Management — Wet 
Nursing and Its Management — Mixed Feeding: 
Breast and Bottle Combined — Feeding Breast- 
Fed Baby After Six Months — Weaning — Arti- 
ficial Feeding and Its Management — Feeding 
After the First Year. 

VII 



CONTENTS 

The Most Frequent Complaints and 
Diseases of the Infant 89 

Inflammation of the Eyes — Scurf — Intertrigo — 
Thrush — Soor — Stomatitis — Colic — Con- 
vulsions — Nasal Catarrh — Earache — Constipa- 
tion — Croup — Vomiting and Diarrhoea — Cry- 
ing. 

Training of the Infant 103 

Playthings — Airing. 

Special Directions . . . 111 

Enemas — Taking the Temperature — Poultices 
— Packs — Compresses — Baths. 

Recipes 119 

Index ... 4 129 



VIII 



INTRODUCTION 

NO problem is more absorbing to the young 
mother or the nurse than the details of the 
care of a new-born infant. Conscientious, pains- 
taking attention is the rule, and it is most essential 
that anything done shall be done right. The care of 
the eyes, of the mouth, of the cord, are all simple 
enough, but they can be carried on with great 
exactness along the wrong lines unless one has 
knowledge of the correct methods. One can, not in- 
frequently, trace illness or failure to gain and grow 
to simple, easily remediable faults in the baby' s 
care. Dr. Lyman has brought together with clear in- 
sight ?nany of the simple but important facts in the 
rearing of infants. I feel that his book will be a great 
aid to nurses and mothers in one of the most beau- 
tiful and pleasant duties of life, and yet one of the 
most important and far-reaching. There is a univer- 
sal appeal in a baby's smiles. We must not be led 
by it to make merely a plaything of the child. We 
must see in the infant the future son or daughter, 
the future citizen, and do all that we can, day in 

IX 



INTRODUCTION 

and day out, to see that development is steady and 
sound along physical^ mental and moral lines. May 
Dr. Lyman s book prove as helpful to its readers 
as the lectures upon which it is based have proved 
to the nurses who have heard them. 

Ray Lyman Wilbur, President 

Leland Stanford Jr. University. 



RULES FOR THE 

MOTHER PRECEDING THE 

BABY'S BIRTH 



RULES FOR THE MOTHER 

PRECEDING 

THE BABY'S BIRTH 

The care of the infant begins with the pregnancy of 
the mother, and she should consult a reputable phy- 
sician as soon as possible so that she may do everything 
to promote the development of her unborn babe. 

She should lead as quiet and regular a life as possible, 
avoiding everything and anything too strenuous for mind 
or body. She should not attend plays, read books or fre- 
quent company which may destroy the peace of her mind or 
get her in an over-excited condition. She should take exer- 
cise every day, preferably by walking in the open air. Danc- 
ing, gymnastics, tennis, swimming and horseback riding are 
best avoided. She should go to bed early and sleep at least 
ten hours. Immediately after the noonday meal she should 
lie down for half an hour. 

The expectant mother can eat almost anything which 
she enjoys and relishes. Only excesses should be avoided, 
particularly over-eating; alcoholic drinks, strong teas and 
coffee, rich foods and salads are best eliminated. A diet 
rich in milk, vegetables and fruit is to be recommended; 
vegetables especially, as they aid in preventing the consti- 
pation which is especially troublesome at this period. 

The clothes should be loose, warm and not heavy. Any- 
thing pressing on the abdomen and hindering the free de- 
velopment of the infant should be done away with. On this 
account corsets should be early cast aside and garments 
worn especially designed for this purpose. The legs and the 
abdomen must be kept warm. High-heeled shoes and 
garters are to be eliminated. 

[3] 



4 CARE AND FEEDING OF THE INFANT 

Baths 

If the mother to be is accustomed to a daily bath, it can 
be continued. It must not be cold enough to be a shock to 
the system or hot enough to be weakening. 

The Breasts 

The breasts must be prepared for the duties ahead. 
During pregnancy they increase in size. Too tight clothing, 
especially corsets, can by pressure hinder the development 
of the nipples. They are likely to grow in or be so insuffi- 
ciently developed that they can not be retained in the 
mouth of the nursing infant. Further, pressure makes the 
skin about the nipple so tender that in the first few days 
following birth it becomes sensitive, fissured and torn. 

During the last month of pregnancy if the nipples are 
poorly developed they should be carefully pulled out and 
gently massaged night and morning. If this does not appear 
successful, a breast pump can be used and the nipples drawn 
out several times daily. 

To harden the nipples cold-water sponging should be 
given night and morning. Sometimes a little diluted alcohol 
is good. However, the latter should be used only under the 
direction of a physician, as it is likely to do more harm than 
good. The alcohol is used with the idea of hardening the 
skin and so preventing fissures, tenderness, etc., later. 



EXAMINATION OF THE 
NEW-BORN INFANT 



EXAMINATION OF THE 
NEW-BORN INFANT 

It is hard to imagine any living thing more helpless than 
the new-born infant; in fact, it is said to be the most 
helpless of all. The young of most species have a highly 
developed instinct and can in part look out for themselves. 
For instance, the new-born chicks are able to walk and 
obtain food for themselves. Not so the infant. It lies where 
it is put, absolutely helpless and absolutely dependent on 
some one to take care of it. Neither is it beautiful to look 
upon, this new-born babe. The head and chest are of about 
an equal size and there is no trace of a neck; the abdomen 
is prominent and protruding; the arms and legs are short 
and clumsy and their movements inco-ordinated; the skin 
and mucous membrane are very red, but become pale in a 
few days; in places the skin is covered with light hairs, or 
lanugo, which will disappear shortly. 

The head is covered with short hairs about one inch 
long. These fall out during the first two weeks. If it has 
been a long, difficult labor the bones of the head often 
overlap and the sides are asymmetrical. The anterior and 
posterior fontanelles are open, the anterior being the larger 
of the two. The bones should be perfectly firm and there 
should be no separation at the suture line. 

A full-term infant should be between twenty and 
twenty-one inches long and should weigh seven or seven 
and one-quarter pounds. The boys weigh a little more than 
the girls. The chest and head circumference are about 
equal — thirty-four cm. The cartilage of the nose and ear 
should be firm, and nails should be flush with the ends of 
the fingers and toes. These points should be kept in mind, 

[7] 



8 CARE AND FEEDING OF THE INFANT 

as a prematurely born babe requires absolutely different 
handling from a full-term infant. 

Pulse and Respiration 

The respiration and pulse vary considerably. In the 
first month the respirations are between thirty and sixty, 
averaging about thirty-five to the minute; during the 
second year about twenty-five. The pulse averages between 
one hundred and thirty and one hundred and forty a minute. 

The Urine 

The urine is practically colorless, sometimes cloudy. 
It is passed from twenty to twenty-five times during the 
twenty-four hours; during the day it is more frequent than 
at night. Often there is a reddish brown spot found in the 
diapers; this is not blood but is due to uric acid crystals. 
Often the urine of the new-born gives the reaction for 
albumen, with acetic acid; this is due to the action of the 
acid on the bladder and ureteral cells present. The urine 
of premature babies at times shows the reaction for sugar. 

The Stools 

The stools of the first two days are dark brown in color; 
they have the consistency of tar and are composed of 
epithelial cells, hair, mucus, gall and cholestrin crystals, 
and are called meconium. The first breast-milk stool ap- 
pears usually on the third day, and is golden yellow and 
has a sour but not unpleasant odor. Two or three stools 
a day are a perfectly normal number. A babe is on record 
who had ten stools a day; they were well digested, normal 
stools but small in quantity — not more than a thimbleful. 
The child gained and thrived and apparently had no in- 
testinal abnormalities. When a child has more than three 



EXAMINATION OF NEW-BORN INFANT 9 

stools daily, and if they are loose, full of mucus, etc., a 
physician should be summoned and nothing but boiled 
water should be given by mouth. 

The Temperature 

The temperature of the new-born fluctuates between 
97. 5 and ioo° F. The heat center in the brain of new- 
born babies functionates very irregularly, and slight causes 
disturb it completely. A subnormal temperature or one of 
99 to 100 is of no importance unless it continues. With 
slight provocation an infant will run a high temperature 
which a few hours later will be normal. When that does not 
persist and is not accompanied by other pathological 
symptoms, it should not excite alarm. 

Infants are extremely sensitive to the surrounding tem- 
perature. A slight chilling will reduce the body temperature 
one-half to one degree, and a hot-water bottle in the im- 
mediate vicinity will elevate it one or two degrees. 

The temperature should always be taken by rectum. 
The axillary or the groin temperature is practically worth- 
less. There are too many conditions which influence it one 
way or the other. 

The Stomach 

The stomach of the new-born is not in a horizontal 
position as in the adult, but lies almost vertical. On this 
account the mother must be very careful in handling the 
baby after feeding; all the food is apt to be pressed out. 
In fact, a baby is like a wet sponge, which retains all the 
fluid if not unduly squeezed. After each feeding it should 
lie unmolested in its bed for ten or fifteen minutes. 

The Nervous System and Sleep 

The nervous system is very weak and inco-ordinated. 
This displays itself by the inco-ordinate movements of 



IO CARE AND FEEDING OF THE INFANT 

arms, legs and eyes, but especially by the tendency to 
sleep. This sleepiness is overwhelming at first. The infant 
is exhausted by the labor and, immediately after being 
sponged and clothed, sinks into a deep sleep, from which 
during the whole first day it does not awaken, and during 
the second day only when it is hungry or uncomfortable. 
Most often it has to be awakened to be fed. The normal 
position of the sleeping infant is with both arms bent at 
the elbow and thrown parallel with the head; both fists are 
doubled and are on a level with the ears. 

Of the special senses only those are early developed 
which are necessary for the new-born babe — temperature, 
pain, taste and smell. Hearing and seeing are developed 
later. The full development of these senses is not reached 
until the end of the third month. However, the new-born 
are very sensitive to loud noises and bright lights and 
should be protected from them. 

Abnormalities and Malformations 

The new-born babe should be examined for abnormali- 
ties and malformations. 

For cleft palate and harelip the services of a physician 
are necessary. Often it is impossible for the baby to nurse 
from the breast or suck from the bottle and there is danger 
of aspiration into the windpipe. 

The physician should also ascertain whether the genito- 
urinary and anal orifices are patent. 

There are several normal manifestations, often mistaken 
for abnormalities, which should not excite anxiety. Some 
of these are described. 

The Caput Succedaneum 

This is an oedema of the scalp, due to pressure over the 
part of the head which presents. It becomes well of itself 



EXAMINATION OF NEW-BORN INFANT II 

in a few days and does not need especial attention, unless 
sloughing sets in. When this pressure tumor contains blood 
it is called a cephalhematoma. It disappears usually in 
two to three months and generally requires no treatment. 

Lanugo 

The short hairs on the lobes of the ears and the shoul- 
ders are called lanugo. They disappear without treatment. 

Icterus of the New-Born 

This is a manifestation often observed in new-born babies 
which is apt to cause great anxiety. Holt says that out of 
nine hundred births at the Sloane Maternity Hospital 
icterus was noted in one-third. This jaundice occurs during 
the first two days of life, and generally terminates at the 
end of five or six days. It does not require treatment. If it 
lasts longer than the time specified and is accompanied by 
fever and other symptoms, a doctor should be summoned. 
Icterus of the new-born is a physiological manifestation. 
After the cord has been tied off, the blood circulation follows 
another course through the liver. This results in an increase 
of blood in that organ, and with the increase of blood there 
is an increased production of bile. As the gall ducts are 
already filled with bile, the increased amount passes into 
the circulation and becomes apparent in skin and mucous 
membrane. 

Swelling of the Breasts 

This is another manifestation in the new-born which 
excites anxiety. It is due to the same stimulus which in- 
creases the size of the mother's breasts. It is said to be 
present in every babe, male and female alike. With some 
babies it is more prominent than with others. It begins on 
the second to fourth day and disappears in a week. On 
pressure a drop of milk appears. The Germans call it Hexen- 



12 CARE AND FEEDING OF THE INFANT 

milch, or witch milk. Almost always it requires no treat- 
ment. If the breasts are very hard it is well to protect them 
from pressure and rubbing with a gauze bandage. It is a mis- 
take to press the milk out, as there is danger of infection. 

With girl babies there is often a bloody discharge from 
the vagina. This may be physiological in nature. At any 
rate, it is best to consult a physician. 

There is one other manifestation of the new-born which 
occurs frequently and which demands the most careful at- 
tention; that is, inflammation of the eyes with formation 
of pus. Under all circumstances a physician should be sum- 
moned immediately. There is danger of the infant's losing 
the sight of one or both eyes. Our asylums for the blind are 
filled with youngsters whose eyes might have been saved 
had they received adequate treatment early. 



PHYSICAL AND 

MENTAL DEVELOPMENT 

OF THE INFANT 



1 6 CARE AND FEEDING OF THE INFANT 

less than this it is not a cause for worry. A good average 
gain per week is four ounces. That a baby gains is the main 
issue. From the second to the sixth month its daily gain 
averages two-thirds of an ounce, and from the end of six 
months on, about one-half ounce daily, so that at the end 
of the first year the boys weigh twenty-one pounds, the 
girls twenty pounds. 

Average Gain of Normal Babies Per Week 



First month 

Second month 

Third month 

Fourth month 

Fifth month 


weekly gain 4 

" "7 

" " 5 

" " 5 

" "6 


Sixth month 


' 4K 
1 3V* 

1 3 

1 1 


Seventh month 

Eighth month 

Ninth month 


V 


Tenth month 


Eleventh month " 


' 2 


Twelfth month " 


' 2 



Average Weight for the First Year 

Birth Weight 7^ Pounds 



End of first week 7 lb. 

End of second week 7 lb. 

End of fourth week 7 " 

End of eighth week 9 

End of twelfth week 11 

End of sixteenth week 12 " 

End of twentieth week 13 " 

End of twenty-fourth week 14 " 

End of twenty-eighth week 15 " 

End of thirty-second week 16 " 

End of thirty-sixth week 17 " 

End of fortieth week 18 " 

End of forty-fourth week 19 " 

End of forty-eighth week 19 " 

End of fifty-second week 20 " 



Fed 


Bottle Fed 




7 lb. 




8 oz. 


7 lb. 


2 oz. 


15 " 


7 " 


8 


' 


10 " 


8 " 


9 


' 


2 " 


9 


12 


4 


8 " 


11 " 


10 




9 " 


12 S* 


7 


4 


11 " 


13 " 


?4 




8 " 


H " 


10 




5 * 


15 " 


9 




12 " 


16 " 


3 


4 


10 " 


16 " 


10 


4 


5 " 


17" 


6 


1 


14 " 


18 w 


2 




8 " 


19 " 


4 





DEVELOPMENT OF THE INFANT 17 

Height 

At birth the average baby is 20-21 inches long 
At six months " " 25-26 

At one year " " 28-29 

Head and Chest 

The circumference of the head and chest remain about 
equal during the first year, at the tnd of that time averag- 
ing between 45.5 and 46 cm. On account of the molding 
of the head during the process of birth, the bones are apt to 
overlap and the sides be asymmetrical. This should not ex- 
cite alarm, as the proportions straighten out during the 
first few months providing the sleeping position is changed 
frequently. Otherwise an obliquity is apt to result. 

The posterior fontanelle closes about the second month; 
the anterior between the twelfth and fifteenth months. If 
the anterior fontanelle closes before the end of the first 
year, there is usually arrested mental development. If it is 
open after the twentieth month, the infant should be exam- 
ined for rickets, myxcedema, cretinism or hydrocephalus. 



The Bones 

At the time of birth the bones are not completely de- 
veloped and are pliable. A slight bowing of the shins, flat 
feet and a symmetrical rounding of the back in sitting 
position, during the first months, are absolutely normal. 
With the development of the musculature these manifesta- 
tions gradually disappear. Many anxious parents think 
these signs are due to rickets; but rickets does not usually 
develop until the fourth month, and its first appearance is 
heralded by cranio-tabes, or softening of the bones of the 
skull, restlessness and sweating of the head. 



I 8 CARE AND FEEDING OF THE INFANT 

Muscular Development 

At the end of three months the babe is able to hold its 
head up when the body is supported; at the end of six 
months to sit up; at nine to ten months it crawls, and be- 
tween eleven and twelve months stands on its feet. Between 
the twelfth and seventeenth months the first steps are 
taken. Many normal babies walk later. However, it has 
been noted that some babies begin to talk much earlier 
than to walk, and those walking earlier talk much later. 
Heredity appears to play some influence. If the mother or 
father has walked late the child is also apt to be tardy. 

The Teeth 

The first set, or milk teeth, twenty in number, appear 
between the seventh and twenty-eighth months, as follows: 

1. The two lower central incisors between 6 and 8 months 

2. The four upper central incisors 8 "io 

3. The other two lower central incisors and 

the first four molars 12 "14 

4. The upper two canine or eye teeth and the 

lower two canine or stomach teeth 18 "24 

5. The four back molars 20 "28 

Pfaundler's rule for the approximate estimation of the 
number of teeth an infant should have at a definite time is 
worth remembering: 

Z = Number of teeth. 
M = Age of infant in months. 
Z = M— 6. 

So an infant of 10 months should have 
four teeth, arrived at as follows: 
Z (teeth) = month — 6 
= 10 — 6 
= 4 

If an infant has no teeth at eight to ten months, a 
physician should be consulted. Delayed dentition occurs 



DEVELOPMENT OF THE INFANT 19 

frequently with rickets and myxoedema. Abnormalities 
occur with spasmophilia, lues, myxoedema and mental 
deficiencies. 

Often infants are born with one tooth. Frequently it is 
necessary to extract it, as it interferes with nursing and 
often traumatizes the mother's breast. 

Teething is not the cause of pathological conditions. 
Healthy infants usually experience no unpleasant symp- 
toms. Frequently it is accompanied by red, swollen and 
tender gums, by increase in the amount of saliva and drool- 
ing, by restlessness, irritability, crying, sleeplessness, loss 
of appetite, and fever. 

Sometimes there are attacks of strophulus, urticaria 
and other skin eruptions, diarrhoea and catarrh of the res- 
piratory passages with cough and convulsions. Just whether 
these symptoms are due to teething is a question over which 
doctors are by no means agreed. Whenever teething is 
accompanied by fever and other abnormal symptoms, the 
mother should consult a physician and not say to herself 
that the baby is teething and let matters go — at this time 
the resistance is lowered and the infant is very susceptible 
to other affections and demands careful attention. 



The Special Senses 

As before mentioned, the senses of heat, cold, pain, 
taste and smell are present at birth. It is said the new-born 
babe can appreciate the difference between fluids which are 
sweet and sour. Sour things cause it to screw up its face and 
turn its head away. Bottle-fed infants are very susceptible 
to the slightest change in temperature or sweetness, and 
refuse the bottle regularly if it is the least bit cold or not 
as sweet as usual. In this connection when the infant re- 
fuses the bottle the mouth and throat should be examined 
for thrush, stomatitis, tonsillitis or pharyngitis. 



20 CARE AND FEEDING OF THE INFANT 



Sight 



At birth the infant is practically as blind as a new-born 
puppy. The pupils react to light, and it has been said the 
eyes are turned in the direction of a bright light, but as 
for seeing it is impossible. A normal babe is able to fix its 
gaze, to follow a light, a match or bright object at the third 
month. 

Recognition of the father, mother and the nurse does 
not develop until between the fourth and fifth months. 
About this time the infant begins to recognize the bottle 
and to hold out its hands for it. 

Many mothers worry because they think their babies 
are cross-eyed. The eyes of the new-born are inco-ordin- 
ated. One eye may be closed, one open; one may be in 
motion and the other remain perfectly still. Co-ordination 
and fixation develop at the third month. A squint is apt to 
be present for the first three weeks. As the eyes of the new- 
born are particularly sensitive, they should be protected 
from too much light, and the room for the first few days 
must be darkened. It must not be forgotten that the new- 
born baby is accustomed to darkness. 

Although a baby cries at birth there are no tears until 
the end of the third month. 

In connection with the tears it may be well to mention 
the smiles. The first one appears about the eighth week 
What appears to be a smile earlier than eight weeks results 
from abdominal colic. 

Hearing 

Directly after birth the babe is stone deaf. As soon as 
breathing commences the middle ear begins to functionate. 
Between the first and the second week the baby starts on 
clapping of hands, ringing of bells and slamming of doors. 



DEVELOPMENT OF THE INFANT 21 

It does not turn its head in the direction of sound before 
the second month. Voices of parents are recognized between 
the third and fourth months. 

These points are important, as it often is possible to tell 
within the first six months whether an infant is mentally 
deficient or not. 

Speech 

From the third month on the infant indulges in its own 
first unintelligible attempts at talking. This takes the form 
of definite words about the first year. "Mamma" and 
"papa" or "da da" are usually the first ones, followed then 
by a few names of objects. Before the second year is up 
simple words are put together and verbs and short sentences 
are acquired. 

If the child does not speak by the end of the second year 
affected tonsils and adenoids should be looked for, and the 
child examined for signs of mental deficiency. But normal 
children may not talk for six months or a year later. 

Sleep 

Twenty hours of sleep should continue for the first six 
or eight weeks. After that time the infant does not sleep so 
much, but should average sixteen hours for the first year 
— a nap of at least two hours in the morning and two in 
the afternoon, in addition to a good twelve hours* sleep at 
night. 

Towards the end of the first year it sleeps less, one hour 
in the forenoon and one in the afternoon. If the infant cries 
when it should be asleep, it is probably wet, hungry, over- 
fed or colicky, has cold extremities or the clothing is too 
tight or is irritating. 



CARE OF THE NEW-BORN 
BABE 



CARE OF THE NEW-BORN BABE 

After the physician is convinced that the new-born 
babe is physically able to combat with its new sur- 
roundings, it should be handed over to the nurse. The nurse 
should see that the cord has been properly tied and that 
there is no oozing of blood, and that the infant cries suffi- 
ciently to expand the lungs fully. 

Care of the Eyes 

The eyes should be attended to at once, first irrigating 
them with a boric acid solution. A medicine dropper can be 
used for this purpose. The physician can hold the eyes open 
and the nurse drop the solution. This should be followed up 
with five per cent protorgal or one per cent silver nitrate 
solution. The latter is not so good, as it is irritating. 

Care of the Vagina 

Great care should be taken of the genitalia of the female 
babies, especially in cases where the mother has been in- 
fected previous to labor. The lips of the labia should be 
separated, the parts sponged from above down with boric 
acid solution and a drop or two of five per cent argyrol left 
between the parts. Quite frequently in perfectly normal 
female babies there is a slight vaginal discharge which per- 
sists for several days, but disappears on treatment with 
boric acid. 

Care of the Cord 

The stump of the cord requires careful attention, not 
only to hinder haemorrhages, but to prevent infection. As 
soon as possible after it is cut it should be dressed. The ver- 
nix caseosa, wherever it would come in contact with the 

I25I 



26 CARE AND FEEDING OF THE INFANT 

bandages, should be wiped off with steril albolene or vase- 
line. The stump should then be surrounded with steril 
gauze and around this the steril bandage should be put. 
Keeping it steril and dry promotes healing. To this end the 
baby is given only sponge baths in the lap of the nurse until 
the cord has separated. The nurse should wash her hands 
carefully before touching the baby, and she should not allow 
the band to become wet or moist. If possible the dressing 
should not be changed until the cord drops off; providing 
there has been no infection this will occur at the end of five 
or six days. At no time should it be twisted to see if it is 
ready to drop off. There is always danger of starting a 
haemorrhage. During the first hours after birth the nurse 
should observe the dressings frequently to see that they are 
not stained with blood, as quite frequently it happens that 
the cord has been insecurely tied, the knots slip, and it con- 
tinues to bleed. 

After the cord has separated it requires a week or so 
before the navel is completely healed, and during this time 
the nurse cannot be too careful. 

Sponging and Bathing 

As before mentioned, until the cord drops off it is abso- 
lutely necessary to keep it dry and steril. On this account 
the complete tub bath is contraindicated until after the 
sixth day, when the cord shrivels up and usually drops off. 
At the time of birth the body is covered with vernix 
caseosa, a fatty, greasy mass, and is stained with blood and 
meconium, etc. The vernix caseosa does not yield readily 
to water, so it is advisable to anoint the body with steril 
albolene or steril vaseline and then rub it off with cotton. 
After this cleaning process the baby should be dressed and 
wrapped in a blanket and put in a warm bed with a hot- 
water bottle near it, as these infants must be kept suffi- 
ciently warm. Before birth they have been surrounded by an 
even body temperature, and until they become accustomed 



CARE OF THE NEW-BORN BABE 27 

to their new surroundings it is necessary to supply artificial 
heat. The babe, exhausted from birth and severe handling, 
sleeps almost continuously for the first twelve or fifteen 
hours, and during this time it should not be disturbed. 

When the infant awakens it should be given the first 
sponge bath, preferably in the morning, on the lap of the 
nurse. To avoid chilling, the water, soap and freshly aired 
clothing should be prepared before the infant is undressed. 
The temperature of the room should be at least 70 F. The 
temperature of the water should be above that of the body, 
at least ioo°. The eyes should be first swabbed out with a 
pledget of cotton dipped in boric solution. A separate dish 
should be reserved and a fresh piece of cotton used for each 
eye. Care should be taken to note any infection. Under no 
consideration should the mouth be washed out. After the 
eyes have been attended to, the ears, face and head should 
be sponged. The water used on the body should not be used 
on the face. A separate basin and sponge should be re- 
served for the face and head. A good mild soap, like Castile, 
should be used. The baby should be undressed, except for 
the band, and the body washed piecemeal, the other parts 
being protected by a blanket so that it does not become 
chilled. All the creases should be washed thoroughly. The 
genitalia of the female babies should be sponged from 
above down, with a pledget of cotton and boric solution. 
During the bath care must be taken that the cord does not 
get wet, or even damp. Under no circumstances should the 
dressing be touched. If the band gets wet, it should be 
changed for a steril, dry one. The bands must be kept ab- 
solutely dry and steril. Not only should they be washed 
and boiled, but after drying they should be pressed with a 
hot iron, which aids in destroying bacteria. 

When the cord drops off", the navel should be watched to 
see that it heals. It should be treated daily with a drying 
powder like dermatol, and a fresh band applied. If there 
is any odor from the stump, or if it does not properly heal 



28 CARE AND FEEDING OF THE INFANT 

and a granuloma forms, a physician should be notified and 
energetic treatment inaugurated. An infection through the 
cord is the most dangerous complication we have to deal 
with. Usually after a month or six weeks the band can be 
discarded. Wearing a band too long tends to weaken the 
abdominal muscles, and to keep it in place it has to be ap- 
plied so tightly that it interferes with comfort and diges- 
tion. It should be removed gradually, a strip being torn off 
daily. If the infant is very thin and there is no adipose tis- 
sue to protect the viscera, it is advisable to wear the band 
a longer time, as chilling predisposes to diarrhoea. 

The Bath 

As soon as the cord has separated, usually on the fifth 
or sixth day, a complete tub bath should be given, pref- 
erably in the morning before the first nursing or feeding 
period. If this seems impracticable, it can be postponed 
until the time of the second feeding. 

As an infant is very susceptible to drafts and chilling, 
the doors and windows should all be closed before the baby 
is undressed. The tub should be placed before an open fire, 
and if there are drafts, surrounded in part by a screen. 

The temperature of the room in the first few weeks 
should be between 68° and 70 F. A complete set of clothes, 
properly aired and warmed, should be near at hand ready 
to slip on. 

The best tubs are the metal ones or the folding rubber 
ones. They should be kept scrupulously clean and used for 
no other occasion than bathing the infant, never for laun- 
dry purposes or as a receptacle for soiled linen. 

During the first few weeks the temperature of the water 
should be above body heat, ioo°to 101 F. After the first six 
or eight weeks the baby should be accustomed to a tem- 
perature of 97 or 98 F., and towards the end of the first 
year 92 to 94 F.^andjat two years 89 to 90 F. The tern- 



CARE OF THE NEW-BORN BABE 29 

perature should be regulated with a thermometer, never by 
the hand. Most hands are accustomed to very hot water 
and there is danger of immersing the infant in too hot 
water. If there is no thermometer at hand, the nurse should 
test the water with the bared elbow; if it feels too warm for 
the elbow, it is too warm for the baby. 

Some nurses prefer to lather the infant with soap in the 
lap and then dip it in the bath water and sponge it clean. 
It always seems that an infant gets unnecessarily exposed 
and chilled this way and that it is better to do all the 
sponging, soaping, etc., in the tub. 

Separate pledgets of cotton and a special bowl of clean 
water should be used for the eyes; in the first days a boric 
acid solution is advisable. The baby's face should not be 
washed in the same water in which the body is washed, and 
separate sponges should be reserved for face and body. The 
reason for this is obvious. 

Castile or some other mild and pure soap is to be pre- 
ferred. During the bath the baby should be immersed up to 
the neck, the nurse supporting it in a sitting position with 
her left hand under the left shoulder, grasping the left arm, 
with the baby's head resting against her forearm; the right 
hand is then free to wash the infant. First the head and 
hair should be soaped and washed; then the body, tak- 
ing care that all the little creases, axilla, neck and ears are 
carefully sponged. It is not advisable to follow up the 
warm bath with a cold sponge. Infants have not enough re- 
sistance for cold water. The baby should not remain longer 
than three to five minutes in the bath; a prolonged bath is 
weakening. 

As the infant grows older and crawls about the floor it 
is advisable to give the daily bath at bedtime. At any rate, 
it should be sponged before being prepared for the night. 

The bath completed, the baby should be enveloped in 
a crash towel, previously warmed, and be dried more by 



3<D CARE AND FEEDING OF THE INFANT 

patting the towel than by rubbing the babe, as the new 
skin is very tender and easily chafed; when it is as dry as 
possible, it should be powdered with zinc sterate or unper- 
fumed talcum powder, especial emphasis being directed 
against all the creases, the axilla and the groins. Care must 
be taken with female babies that the powder does not col- 
lect between the labia; it is apt to set up irritation. A 
pledget of cotton dipped in the talcum affords the most 
satisfactory means of powdering. It can be used once and 
thrown away; the puff is unhygienic, being used to powder 
genitalia, buttocks and body. 

Insufficient drying is dangerous to the infant. Not only 
is the skin irritated, but a damp skin predisposes to con- 
tracting a cold. 

The ears need especial attention, and should be dried 
out with a blunted toothpick about which a pledget of cot- 
ton has been wound, so that the delicate drum-membrane 
is not injured. 

The nose is cleaned in the same way. It is impossible to 
nurse when it is stopped up, so the nostrils should be kept 
clear, with a cotton applicator smeared in vaseline. 

The nails should be cleaned with a blunted toothpick 
and kept short to keep the infant from scratching itself. 

After the bath and the powdering, the navel should be 
properly bandaged and the infant dressed, put in bed and 
given its feeding and allowed to take the morning nap. 

As for the mouth it should never be cleaned. Old nurses 
have a habit of swabbing it out with an index finger around 
which a pledget of gauze or cotton, dipped in boric acid 
solution, has been wound; the tender mucous membrane is 
easily excoriated and a stomatitis or thrush results. At best 
this mouth cleaning has no significance, as an infant has not 
any teeth about which food remains might collect. When 
the teeth have made their appearance they should be 
cleaned once a day with a soft rubber toothbrush. The 



CARE OF THE NEW-BORN BABE 31 

brush must be kept scrupulously clean and be boiled before 
being used. 

The Baby's Room 

The room for the baby should be the airiest, sunniest 
and pleasantest room in the house. It should be on the 
sunny side with an eastern, southeastern or southwestern 
exposure. A corner room with windows facing east and 
south or a southwest room is the most satisfactory. Above 
all, the room should be dry and not too well shaded by 
trees, and it should have windows sufficient to afford plenty 
of light and fresh air. One window should always be open, 
and if there is a draft the bed should be surrounded by a 
screen. Light is just as important as air and a deficiency is 
said to predispose to nodding spasm or spasmus nudans. 

For a new-born babe the room temperature should be 
between 68° and 70 ; after two or three months, 64 to 66°. 
During the night it should not be allowed to get cooler than 
58 or 59 . It is not good to get the child accustomed to too 
warm a room, as a hot, stuffy atmosphere predisposes to 
nasal catarrh and bronchitis. 

As soon as the infant is old enough it should sleep in a 
room alone. The apartment where the baby sleeps should 
never be used for cooking, washing or ironing, as a damp 
atmosphere is extremely unhealthful. 

The furnishings should be of the simplest. Everything 
should owe its presence to utility and never to ornamenta- 
tion. White furniture is the most appropriate, as it can be 
readily cleaned with antiseptics when the occasion arises. 
A white-enameled iron or brass bed, with high sides, a 
bureau, a table and a couple of chairs are all that are 
necessary. 

The curtains should be of the simplest, without any 
draperies or hangings; everything and anything which is 
apt to collect dust should be avoided. No upholstered 



32 CARE AND FEEDING OF THE INFANT 

furniture should be countenanced. A wooden, polished or 
painted floor is the most hygienic. This proves satisfactory 
for the infant in arms, but not for the child beginning to 
crawl and walk, when it is liable to be dangerous; a rug 
can be used then. The walls should be painted or simply 
papered. 

On account of ventilation it is well to have a fireplace 
in the room. When that is impossible, a stove is preferable 
to a gas or oil burner. 

None of the furniture should have sharp corners or pro- 
jections with which the toddling youngster might come in 
contact. 

The artificial lighting should be electric and so arranged 
that it does not flare in the baby's eyes when turned on at 
night. 

The room should be well ventilated, one window always 
open winter and summer, day and night; and two or three 
times during the day the babe should be taken into an ad- 
joining room while all the windows are opened and the 
room well aired out. This should be done for the last time 
just before the infant is put to bed for the night. 

When the infant sleeps, the room should be absolutely 
quiet. Waking it up by loud talking or unseemly noises in 
the adjoining apartments predisposes to the making of a 
nervous child. 

When the baby is old enough to sit, a little stall should 
be supplied; here the infant is protected and can exercise 
its limbs freely by kicking and rolling around, and soon 
learns to stand upon its feet and to take the first faltering 
steps. 

The room should never be swept or dusted when the 
infant is in it. All cleaning should be done with a damp 
cloth and a carpet-sweeper. Plants and flowers are not 
desirable. 



CARE OF THE NEW-BORN BABE 23 

The Bed 

The most important article of furniture in the baby's 
room is the bed. If possible it should be in a room by itself 
and so placed that there is no chance of draft between doors 
or windows; if this is impossible it should be protected by 
a screen. 

The most satisfactory bed is of enameled iron or brass. 
It is easily kept clean. The sides should be high, one 
arranged so that it is lowered or raised at will. The bed 
should be well off the floor so that no draft sweeps across it. 

The sides should be lined, especially for a new-born 
babe. The mattress should be of hair, and firm so that the 
youngster does not sink into it. Feather mattresses are 
bad to use, because they keep the infant too warm and 
there is no chance of evaporation, so that the body is con- 
tinually bathed in perspiration, which predisposes to dif- 
ferent forms of skin eruptions. The new-born babe does not 
need a pillow; as it grows older one of hair should be sup- 
plied. The feather pillows are bad for the same reason that 
feather mattresses are. A perspiring head predisposes to 
furunculosis. 

The infant's position should be frequently changed. It 
should not be allowed to sleep too long on one side. A 
change tends to make the head symmetrical; lying too long 
on one side tends to produce a flatness; it is necessary to be 
especially careful in rickets. 

A thin rubber sheet should cover the mattress to keep 
it from getting soaked with urine. 

A baby's bed is made up like other beds. In cold weath- 
er the sheets should be warmed with a hot-water bottle. 
The under one should be of cotton, the upper a thin woolen 
one. Except for the first few days the infant should not sleep 
between the folds of a blanket. When the baby is prepared 
for the night the clothes should be pinned in place on either 



34 CARE AND FEEDING OF THE INFANT 

side; then there is no danger of taking cold from becoming 
uncovered. 

In summer the bed and baby buggy should be pro- 
tected from insects by a piece of netting. It should be out 
of the baby's reach and should not interfere with the cir- 
culation of air. 

Canopies and curtains should be done away with. They 
cut off the supply of fresh air and collect dust. 

A rocking cradle gets the infant in bad habits; a baby 
goes to sleep just as well without motion of any kind. 
Rocking and trouncing after eating often cause regurgita- 
tion of food. Moreover, once this practice is begun it is hard 
to break. All that a baby needs to put it to sleep is a full 
stomach, dry diapers, a warm dry bed, a supply of fresh 
air and absolute quiet. 

When it is impossible to buy an iron bed, a lined clothes- 
basket with a comforter for mattress serves the purpose 
just as well. The basket, on account of draft, should not 
rest upon the floor; the top of a steamer trunk serves as a 
good pedestal. I know of one poor mother who could 
afford neither bed nor basket and who used a deep bureau 
drawer propped up on two chairs. The child slept in this 
improvised bed for weeks and thrived. Two infants should 
not sleep in the same bed, and the babe should never sleep 
with the mother. Too many worn-out and tired-out mothers 
have rolled over and suffocated their sleeping infants. 

Where there is more than one baby in a family they 
should sleep in separate rooms if possible, as the one fre- 
quently disturbs the rest of the other. 

Baby Clothes 

The infant's clothes are intended to keep the body 
warm and should be chosen with this in mind. They should 
be as simple and as loose as possible, and there should be a 



CARE OF THE NEW-BORN BABE 35 

plentiful supply. Improper and inappropriate clothing does 
harm. If too warm there is no chance of evaporation; the 
body is continually bathed in perspiration, the baby is pale 
and listless and the musculature weak. It does not gain in 
weight and is predisposed to colds and skin eruptions. If 
too tight and the infant is wrapped up like a mummy the 
digestion, blood circulation, respiration and the full play 
and development of arms and legs are interfered with. Too 
tight clothing can cause vomiting. Often doctors and 
parents are in a quandary over a crying baby, but the 
crying ceases as soon as its clothes are removed and it is 
wrapped in a blanket. Not keeping a baby warm enough is 
just as injurious. Too great cooling predisposes to diarrhoea. 
All infants are susceptible to heat and cold, and should be 
dressed according to the season. When the weather is hot 
the diaper and a shirt are all that are necessary. As the 
weather grows colder, other clothes are added. A good guide 
as to whether the infant is properly clothed is to feel the 
feet; if they are cold and clammy the infant is insufficiently 
clothed. Cold feet are the chief cause of indigestion, colic, 
hiccoughing and fretting. 

It is better to avoid pins and safety pins in dressing. 
They are apt to become unclasped and stick or scratch the 
infant. Tapes are the most suitable means of keeping the 
clothing together. After the infant is dressed, and often 
during the day, the clothes should be pulled out and 
straightened. Folds and wrinkles interfere with its comfort. 

New clothes should be washed and boiled before being 
used, not only because they are stiff and starchy, but to 
avoid any chance of infection. They should be laundered 
soft so that there is no chance of scratching or chafing. 
New flannel is particularly irritating and should be exam- 
ined carefully for rough ends. All clothes, before being used, 
must be thoroughly dried, aired and ironed. Ironing helps 
to destroy bacteria. A flannel band is necessary when the 
cord drops off; none is required after the first month. If one 



$6 CARE AND FEEDING OF THE INFANT 

is desired linen mesh can be used. Wearing a band too long 
prevents the complete development of the abdominal 
muscles. 

The following list of garments are recommended and 
advisable for the infant's outfit: 

6 flannel binders (\% yards long — 4 inches wide). 

6 shirts — wool, wool and silk, or cotton. 

6 inside shirts with or without arms — cotton, silk, or 

thin silk and wool. 
6 "Gertrude" pinning blankets with shoulder straps — 

open down the front. 
6 pair of knitted socks. 
3 pair worsted booties. 
6 muslin or cotton petticoats. 
6 white muslin slips. 
3 dozen linen diapers (25x50 inches). 
3 dozen congress material or thick cheesecloth diapers 

(22x44 inches) . 
1 knitted jacket. 

1 flannel jacket. 

2 caps — one thin, one thick. 
1 cloak. 

12 bibs. 
1 pair mittens. 
1 knitted blanket. 

When the child begins to crawl on the floor the clothes 
should be loose and shortened; rompers are then advisable. 
Soft leather booties should take the place of the knitted 
ones, and long socks. Wearing of half silk socks is bad 
except in climates where the children can stand to have 
two-thirds of their little legs exposed to the raw air. Many 
children have been lost in the hardening process. 

When the infant begins to walk, shoes instead of booties 
should be worn. The shoes help to support the ankles. 



CARE OF THE NEW-BORN BABE 21 

The Diapers 

The diapers are the most important appendage of the 
baby's wardrobe, and there should be a plentiful supply of 
scrupulously clean ones always on hand. It is easy for a 
mother to calculate the number when she realizes that the 
new-born infant soils about twenty in twenty-four hours, 
and as long as the baby remains on a fluid diet the number 
does not diminish materially. Old linen makes the best 
ones. If the material is new it should be washed and boiled 
for fifteen minutes before being used. If not it is too stiff 
and fails to absorb properly, the urine runs off and its mis- 
sion fails. For the new-born two diapers should be used, an 
inner one made of some soft, very absorbent material 
which collects all the excreta, and an outer one of linen. If 
desired, during the first few weeks a square of old linen six 
by four inches can be used. This fits in the inner diaper, is 
not at all bunglesome and after being soiled can be thrown 
away. This is a very practical method and saves much work 
in the laundry. Arnold manufactures a most excellent 
one; it is about the size of a wash cloth and made of a 
peculiar knitted material which absorbs very readily. It is 
used in connection with the inner diaper and is easily 
laundered. 

When the infant reaches the age of eight or ten weeks it 
is advisable to put a thin piece of rubber sheeting between 
the folds of the inner diaper. It saves the baby's clothes and 
bed linen from being continuously soaked. One should be 
careful that the rubber does not come in contact with the 
skin. 

Before being used the diapers should be warmed 
through. A good practice is to keep a set properly folded 
ready for use, warmed about a hot-water bottle. In this 
way, when it is necessary to change, the infant does not 
receive a shock from a cold diaper. 

A diaper ready for application is three-cornered; the 



38 CARE AND FEEDING OF THE INFANT 

thin inner one is first firmly and smoothly fastened about 
the infants body, the third corner being brought up be- 
tween the legs. Then the outer one is similarly put in posi- 
tion. It is not necessary to bring the third end of the outer 
diaper between the legs. That makes it very bunglesome, 
especially with a young infant. This end may be left free. 
The diaper must not be so tight that it hinders digestion 
or chafes the baby's legs or prevents their free motion. It is 
better to pin it firmly in position than to knot or twist the 
ends. The knots and twists often prove uncomfortable. 

Above all the diaper must not be voluminous, as a too 
bunglesome one between the legs is said to predispose to 
their bowing. 

Woolen and flannel diapers are absolutely to be 
avoided. They are too clumsy, keep the baby too warm and 
prevent evaporation of moisture. It is important that as 
much moisture as possible evaporates and that the warm 
urine does not soften and irritate the tender flesh. 

At best the diaper with its many folds and pins hinders 
the free motion of the infant. It is an art so to arrange it 
that it is not too tight and still not so loose that it is easily 
kicked off to hobble the small legs. 

Once a day for about fifteen minutes, the baby's room 
being comfortably warm, the clothes, with the exception 
of the shirt, should be removed and the infant allowed to 
kick its legs and stretch freely. 

Further, it is important to remember that when a dia- 
per is wet it is not to be dried and reused, as it is irritating 
to the tender skin of the baby. The soiled diapers must be 
laundered before being used again. Simply washing in hot 
water and soap is not sufficient; they must be boiled for 
fifteen minutes, thoroughly aired, dried and ironed. A good 
non-irritating white soap should be used. 



CARE OF THE NEW-BORN BABE 39 

Soiled Diapers 

The soiled diapers must not be kept in the room with 
the baby. They should be placed in a covered pail and kept 
on a back porch, or in a handy storeroom. They should be 
roughly washed out as soon as possible and kept soaking in 
clean cold water until they can be thoroughly washed in 
hot water and soap and boiled. 

Changing of Diapers 

A new-born babe, and one even up to six or eight months 
old, passes its urine about eighteen times in twenty-four 
hours, more often during the day and after nursing, and 
has two to three stools in that time. 

Theoretically, the infant should be changed as often as 
it wets; practically, this would be a mistake, as it would 
have no opportunity to sleep. A well-fed and thriving baby 
sleeps directly after the bottle from one to two hours, and it 
is best to leave this sleep undisturbed. Directly before the 
nursing or feeding time it should be put in dry diapers and 
properly powdered. It is a bad practice to change after 
nursing. The infant is sleepy then and at this time it vomits 
and regurgitates very easily on being handled. After nurs- 
ing or the bottle it should be laid quietly in bed. If, after 
an hour, it awakens crying and appears uncomfortable, the 
diapers should be changed. On an average ten changes in 
twenty-four hours generally prove sufficient for its com- 
fort. It is only advisable to awaken it to change its diapers 
when the buttocks and parts are tender and excoriated, as 
wet diapers tend to aggravate the condition. 

As too frequent sponging makes the skin sensitive it 
is not necessary to wash the parts after each wetting, unless 
the condition, such as chafing, warrants it. Usually drying 
and a light powdering are sufficient. As before mentioned, 
it is bad practice to put the powder on too thick. It leads 



4-0 CARE AND FEEDING OF THE INFANT 

to bad results, especially with girl babies, when it is apt to 
collect under the labia and start up an irritative process. 

When the baby has had a stool, the diapers should be 
changed immediately, and the buttocks and between the 
legs sponged with warm water. Care must be exercised with 
female babies to wash them from before backward, as there 
is danger of intestinal bacteria entering the urethra and so 
exciting a cystitis or pyelitis. 

After a proper cleansing the parts should be lightly 
powdered and the baby rediapered. 

An unscented talcum or zinc powder is the best to use. 

Night Clothes 

The diapers should be the same as during the day. At 
first the two little shirts should be changed for two other 
similar ones. Later, only one undershirt is necessary. Linen 
mesh proves the most satisfactory. Over all the infant 
should wear a long nightgown. In warmer climates, for 
older children, one of cotton affords sufficient warmth. For 
very young and new-born babies and in cold climates cotton 
flannel is the most satisfactory. 

The hem should be made with a drawstring; this pro- 
tects the feet from becoming exposed and getting cold. A 
nightcap is unnecessary. The greatest care should be taken 
that the infant does not get chilled in changing its clothes. 
A baby is very susceptible to chilling; on this account all 
changing of clothes, and especially of diapers, should be 
as rapid as possible. It expedites matters, particularly 
during the night, if the diapers and clean night shirts are 
all ready to slip on. 

The Baby Buggy 

The buggy is about as important as the bed. In fact, 
many infants sleep entirely in their buggies. At any rate, 
they spend a good part of each day therein. 



CARE OF THE NEW-BORN BABE 4I 

The best ones are of wicker. They permit the circula- 
tion of air better than the wooden leather-lined ones. The 
buggy should be 90 cm. long, 45 cm. wide and 3$ cm. deep. 
The head should be as deep as the foot so that there is no 
danger of the infant's rolling out. The gondola-form and the 
half-wagon are not to be recommended, because the baby 
lies too exposed and there is danger of draft. 

For the lining some kind of cloth is more suitable than 
leather, as the latter is heating and prevents all circulation 
of air. The mattresses, covers, etc., should be arranged as 
in a bed. 

The buggies which are suspended by springs are awk- 
ward, as there is a possibility of pitching the youngster out 
on striking an obstacle. 

Continuous shaking and rocking is a bad practice. It 
encourages a habit which is to be avoided. 

The top should be lined with blue, gray or green; all 
these shades exert a good influence on the eyes. White re- 
flects light and is irritating. 

Curtains hanging from the top defeat the purpose of 
giving the baby an airing; they keep the air out. Nothing 
in the shape of a ball or rattle should be allowed to dangle 
from the top in front of the baby for the purpose of enter- 
tainment. The infant tries to fix the eyes on the dangling 
object and so a squint develops. 

As the baby grows older it is necessary to have a strap 
about the body, connected to the buggy; then there is no 
danger of its pitching out when it is left for a moment. 

Kissing 

Most mothers nowadays realize the danger of promis- 
cuous kissing of infants. It is the most plausible and prob- 
able way of spreading infection, especially tuberculosis and 
throat affections. All kissing should be prohibited, or if 



42 CARE AND FEEDING OF THE INFANT 

allowed should be confined to the back of the neck. Kissing 
the hands is just as objectionable, as they are continuously 
coming in contact with the mouth. 

Lifting 

As the infant is incapable of supporting its own head 
one should always be careful to slip one hand behind the 
head and neck before picking it up. This is best accom- 
plished by raising the legs with the right hand and slipping 
the left hand under the body to the head and shoulders. 
Then the infant can be lifted and supported on the left 
arm. It should never, before the fourth month, be taken up 
by grasping it under the arms; after the baby is able to 
support its head, this is the best place to take hold; it 
should never be raised by taking the wrists. It is very easy 
to dislocate the joints or cause a separation between the 
head and shaft of the bone. 

Throwing the baby into the air and catching it is mis- 
treatment; it may be dropped or the ribs be fractured by 
rough handling. 

Carrying 

The infant should be carried first on one arm and then 
on the other, never entirely on one; otherwise it gets into the 
habit of using one hand and arm almost entirely, and the 
other does not properly develop. 

The infant also gets into the habit of holding its head 
and body in one position, which frequently develops into 
deformity. Until after the sixth month it should never be 
carried without supporting the back. 

Weighing the Baby 

During the first year the infant should be weighed 
twice during the week and a record kept in a book. Daily 
weighing has little significance. The most convenient time 



CARE OF THE NEW-BORN BABE 43 

is in the morning immediately before the bath, when it is 
stripped. It should always be done at the same time and 
under the same conditions, otherwise it has little value. 
If desired, the baby can be weighed in its clothes, then a 
duplicate of the garments weighed and subtracted to get 
the exact weight of the infant. 

The scoop of the scales should be covered with a small 
crash towel of known weight, and both should be previously 
heated with a hot-water bottle before the naked baby is 
put on; otherwise the cold metal gives a shock. 

Care of the Ears 

The mother or nurse should not allow the infant to 
sleep with its ear doubled under. Such a practice, persisted 
in, results in the ears growing straight out. To prevent this 
from occurring, the infant should wear a cap of tape or net 
to keep the ears close to the head; or bands of adhesive 
plaster should be applied. Care must be taken with the 
latter method that the ears do not become irritated. The 
bands of adhesive can be removed with benzine. 

Care of Premature and Weak Infants 

Premature babies are those infants born before nine 
months of pregnancy have expired. 

Weak infants are abnormally small twins or the off- 
spring of parents suffering from some chronic disease such 
as syphilis or tuberculosis. 

All of these infants have an abnormally low body 
weight. A normal full-term baby weighs seven to seven and 
one-quarter pounds. These premature and weak ones often 
weigh less than four pounds. A number of cases are on 
record which were saved and which weighed between two 
and three pounds. The percentage of deaths is very high. 

Also all of these infants have a tendency to subnormal 
temperature. It is impossible for them to keep up their own 



44 CARE AND FEEDING OF THE INFANT 

body heat. On this account it has to be supplied artificially, 
as the greatest danger lies in their becoming chilled. The 
temperature of a normal infant is between 98 and 99 F.; 
of premature infants around 95 and 96 F. It is necessary, 
therefore, to protect them from giving up their body heat 
and to supply it artificially. The latter can be accomplished 
with earthenware bottles filled with hot water or hot sand. 
The bottles should be placed in the bed, one on either side 
of the infant, and one across the foot of the bed. They 
should be changed every hour. The temperature of the 
room should be at least 70 F. 

To prevent the loss of heat the body should be smeared 
lightly with vaseline, and then the infant enveloped in cot- 
ton, from head to toe, only the face being exposed. If de- 
sired the clothes may be put on over the cotton covering. 
These infants should be kept in a warmly lined bed, pref- 
erably with a pillow for mattress. 

When possible an incubator should be procured. It 
serves three purposes: 

Provides an even temperature. 

Supplies and prevents loss of body heat. 

Protects the infant from infection. 

The lightest infection is disastrous, and the infant must 
be protected from head-colds, bronchitis, etc. An incubator 
is dangerous in that it requires constant attention to pre- 
vent overheating, which usually results disastrously. 

The supply of fresh air must be regulated, and precau- 
tion taken that it does not get dried out, by supplying a 
small cup filled with water which can be attached to the 
side of the incubator. 

Feeding of Premature and Weak Infants 

The feeding of these premature babies is a problem. 
1. They have an abnormal tendency to sleep. They do 
not awaken at meal times like normal babies, and when 



CARE OF THE NEW-BORN BABE 45 

they are awakened they go to sleep again almost immedi- 
ately without taking their food. 

2. They are too weak to suck on the breast. The milk 
has to be expressed and the infant fed with either a spoon 
or pipette or by gavage. 

To save these babies breast milk is almost an absolute 
necessity. Where it is impossible to obtain an adequate 
supply it is necessary to resort to a whey-cream mixture. 

On account of the inco-ordination of the central nervous 
system and lack of development of the respiratory center, 
these premature infants are in constant danger of sudden 
death. They suddenly cease to breathe and become blue. 
At best breathing is superficial. Oxygen should always be 
kept at hand for these attacks, and when the nurse notes 
that the infant is cyanotic and blue, she should do every- 
thing in her power to stimulate respiration by spanking, 
sprinkling cold water in the baby's face, pinching the 
cheeks, artificial respiration, etc. 

If the infant has one such attack, it is likely to have 
others, and requires constant attention. It is also predis- 
posed to spasmophilia and convulsions. 

It is also necessary to be very careful in bathing these 
infants. The temperature should be at least 101 to 103 F. 
All unnecessary cooling and exposure should be avoided. 

Treatment of Asphyxia ' 

Often it is difficult to get the new-born babe to breathe. 
In such case the nurse should clean the mucus from the 
throat with a piece of gauze wrapped about the index fin- 
ger; then the infant should be held aloft by the feet to give 
the mucus, liquor amnii, etc., a chance to escape. 

If these measures do not succeed in producing respira- 
tion, it is necessary to resort to stimulation and artificial 
respiration. 



46 CARE AND FEEDING OF THE INFANT 

Stimulation is best administered by slapping the baby 
on the buttocks or on the soles of the feet, or by vigorous 
rubbing of the body with a towel, blowing in the baby's 
face or sprinkling with cold water. One author suggests 
tickling the nose with a feather. Often this produces loud 
crying and breathing begins. 

If this is not successful, stronger stimulation is neces- 
sary. The infant should be alternately dipped in ice water, 
then taken out and dipped in hot water. It may be neces- 
sary to repeat this procedure several times. 

If this is not successful, it is necessary to resort to arti- 
ficial respiration. There are several methods: 

1. Mouth-to-mouth insufflation. The child's head is ex- 
tended and the mouth covered with gauze and the physi- 
cian expires or blows forcibly down the infant's throat. 
Quite often this succeeds in inducing crying and therefore 
breathing. 

2. Another method is to support the infant's back with 
one hand and, taking the legs in the other, bend the body 
back and forth at the hips so that the legs approach the 
chest. It is necessary, often, to repeat this many times. 

3. Schultze's swinging method. The infant is held in the 
physician's or nurse's hands, face to front, thumbs over 
shoulder, index fingers in axilla and the rest of fingers sup- 
porting the back. The child is then swung alternately be- 
tween the knees and over the head, flexing the head upon 
the chest in the latter position. 

4. A simple method is to lay the infant on a table, face 
up, then with both hands to press the chest rhythmetically. 



INFANT FEEDING 



INFANT FEEDING 

Breast Feeding 

There is only one food intended for the new-born 
babe, and that Nature supplies in mother's milk. 
For nine months previous to birth the placenta provides, by 
means of the blood, whatever nourishment is needed for the 
developing foetus, and, after birth, the last thing the pla- 
centa does is to secrete a body called a "Homone," which 
stimulates the mammary gland to secretion, so that Nature 
intends breast milk for the baby, and the infant's diges- 
tive powers are adapted only to this food. What Nature 
supplies for the young calf or goat was never intended for 
the delicate infantile digestion, and those who attempt to 
give unmodified cow's or goat's milk to a baby learn this 
to their sorrow. 

Nature supplies the young of every species with a milk 
adapted to that species alone. Experiments with animals 
have shown that feeding the young of one with the milk 
intended for another ends disastrously. So it is the mother's 
bounden duty, whenever possible, to supply her infant 
with the food intended for it, and if she does not do so she 
breaks a law of Nature, and whoever defies those laws pays 
for it in one way or another. Unfortunately, it is not only 
from the mother that Nature exacts punishment, but es- 
pecially from the infant. The baby is apt to pay with intes- 
tinal disturbances, and a lessened resistance against in- 
fectious diseases, to say nothing of the conditions resulting 
from artificial feeding, such as rickets, scurvy, etc., and 
the mother is apt to pay by an incomplete recovery from 
her pregnancy and many times by haemorrhages. She be- 
comes subject to many female complaints. It is a fact that 
a child sucking on the breast stimulates contraction of the 

[49] 



5<D CARE AND FEEDING OF THE INFANT 

uterus and stops bleeding. One author has said that moth- 
ers who have nursed babies are not so subject to cancer of 
the breast and uterus as are other women. 

Every one who has had experience with infants knows 
that the breast-fed ones are developed mentally and physi- 
cally far better than the artificially fed. At the end of one 
year the breast-fed baby is one to two pounds heavier and 
one-half to one inch longer. It is stronger, and the mother's 
milk supplies a protecting body against infections which is 
lacking in artificially fed infants. Statistics show that the 
breast babies are not so subject to infectious diseases, such 
as measles, whooping cough, etc., and it is a fact that where 
one breast-fed baby dies eight bottle-fed ones succumb to 
one complaint or another. Not only does breast milk ap- 
pear to immunize against infectious diseases, but babies fed 
on it are not subject to the intestinal disturbances which 
decimate our artificially fed infantile population. 

It stands to reason that breast milk is the natural and 
healthful infant food. It is manufactured in the breast, 
passing pure and fresh, at body temperature, into the in- 
fant's stomach. There is no chance of its becoming infected 
and it requires no scientific modifications and consequent 
handling. 

Some recently published military statistics show that 
the breast-fed infant is physically superior, not only in in- 
fancy, but also during its whole life. And, probably most 
important of all, the tie between mother and child is 
stronger if the infant receives its nourishment from the 
maternal breast. 

It is said that 90% of all women are able to nurse their 
babies, but only 30% are willing. The others cease for one 
reason or another, but the mother who gives it up because 
she believes that nursing ruins her figure^does not deserve 
the name. Some one has said that motherhood is a woman's 
most sacred and privileged calling, and the first duty it 



INFANT FEEDING 5 I 

entails is nursing the baby on the breast. The ancient 
Hebrew, Greek and Roman women were compelled by law 
to nurse their babies, and were punished if they did not. 
The ancients realized their children received a start in life 
in this way that could be made up in no other way. Many 
mothers are forced to give up nursing on account of their 
work; to meet this contingency, several German cities have 
a system by which the mothers who are employed in fac- 
tories are able to nurse their babies for six weeks. Their 
hospital expenses for that length of time are paid out of 
the Krankenkasse, or governmental fund for the sick. One 
Berlin orphan asylum, where necessary, even supplies wet 
nurses for deserted infants until they are in a condition to 
be fed on artificial food. It is measures like these which 
have reduced the enormous infantile mortality. In coun- 
tries where breast feeding predominates, the mortality is 
much less than in countries where it is on the wane. For 
instance, in Norway it is 8%; in Sweden 9%; in Germany, 
where artificial feeding is common, it is 26%, and in New 
York about 20%. It is certain that if a woman is able to 
carry a baby for nine months she is able to nurse it for a 
corresponding length of time, and it should be the right 
of every infant to suckle on the breast, and it is the mother's 
duty not only to nurse her babe, but to do everything in 
her power to increase the quantity and quality of her milk. 
When one realizes the advantages of breast milk over 
artificial feeding, everything should be done to encourage 
the nursing mother. It is claimed that any well one has 
good milk. Nursing should be given up only on the advice 
of a physician. Fever, anaemia, weakness, nervousness and 
backache are not sufficient reasons for weaning. 

Contraindications to Nursing 

Tuberculosis. 

Chronic heart and kidney diseases. 



52 CARE AND FEEDING OF THE INFANT 

Inflammation of the breast with the presence of pus in 
the milk. 

Septic diseases. 

Epilepsy, hysteria and the lesser mental disorders are 
not contraindications so far as the milk is concerned. There 
is no chance of inheriting character or mental defects 
through the milk. The only danger lies in the fact that the 
mother might injure her offspring during an attack. 
Syphilis in the child is not a contraindication, if the mother 
has shown no symptoms but the new-born infant has; 
there is no danger to the mother as she is probably immune. 
If the infant has syphilis it should not be put to suckle on 
the breast of a non-syphilitic wet nurse. A primary lesion 
of the mammary gland is not unknown. 

Many authors claim that there is only one contra- 
indication to nursing and that is tuberculosis. There have 
been several cases of infants who nursed while the mother 
had typhoid fever, with no untoward results. Measles and 
scarlet fever are not necessarily contraindications, unless 
the mother is in a dangerous condition. Up to six months 
the nursing infant seems to be immune to all infectious 
diseases. 

If a mother is ill with an infectious disease it takes 
several days before a diagnosis can be confirmed. During 
this time the infant has been subjected to the infection, and 
if it contracts the disease it stands a better chance of re- 
covery on the breast than on artificial food. 

Menstruation and Nursing 

It is said in fully one-half of nursing mothers menstrua- 
tion intervenes before the baby is weaned. It is no contra- 
indication to nursing and it is not necessary to wean. 
Menstruation makes no difference in the chemical con- 
stituents of the milk. However, some authors claim that it 
reduces the fat and increases the proteid. It does diminish 



INFANT FEEDING 53 

the quantity for a few days. In ninety per cent of the cases 
the infant shows no untoward symptoms. Sometimes it has 
a slight diarrhoea or vomits. 

Pregnancy 

A nursing mother very rarely becomes pregnant. When 
she does, it is best to wean the infant; best for the mother 
and best for the baby. The milk is poor in quality and the 
mother needs all her strength in the development of the 
foetus. However, there is no immediate hurry and the 
weaning should be done gradually. 

Difficulties in Nursing 

There are a number of difficulties encountered, in both 
the mother and the child, which are not contraindications, 
but demand care and attention. 

Many mothers give up nursing because their nipples 
are too small, flat or sunken so that the baby has difficulty 
in getting a grip. Many infants learn to nurse without the 
nipple and drink as one would from a sponge. If this seems 
impossible a breast shield can be used. 

Sometimes the breast is so hypersensitive that the 
mother cannot stand the pain resulting from nursing. Here 
the number of feeding periods should be temporarily re- 
duced and the nipple treated with one per cent silver 
nitrate. 

Mastitis, rhagaden and fissured breasts require pro- 
fessional attention. Weaning is unnecessary and uncalled 
for. 

On the part of the infant one of the difficulties encoun- 
tered is weakness. Many new-born, especially premature 
babies, are too weak to suckle. In these cases the milk must 
be expressed and the infants fed with a medicine dropper 
or bottle. 



54 CARE AND FEEDING OF THE INFANT 

With cleft palate and harelip it is often impossible to 
nurse. The milk in these cases should be expressed. Often 
it is necessary to feed by gavage until the misformed parts 
are repaired. 

When an apparently normal baby refuses to nurse, it 
should always be examined for inflammation of the mouth, 
tonsils and pharynx. Many apparently well babies refuse 
the breast because it is painful to nurse and swallow. 

Care of the Nursing Mother 

The nursing mother should take the best care of herself. 
Everything should be made as agreeable and pleasant as 
possible. Anything upsetting the nervous system is apt to 
result in a diminution of the quantity or total cessation of 
milk. Fright, worry, grief, fatigue or any great excitement 
should be avoided. Emotion tends to alter the composition 
and quality of the milk and is apt to make the child vio- 
lently ill. 

If the mother wishes to nurse her infant successfully, 
she should live as simple a life as possible, avoiding all 
nervous excitement and eliminating all social engage- 
ments during the nursing period. She should take regular 
exercise, daily, preferably by walking. Plenty of fresh air, 
simple food, sufficient sleep, rest and no worries, are the 
absolute requirements of the nursing mother. 

The Food 

The food should be as simple and appetizing as pos- 
sible. Many mothers ruin their appetites by a too plen- 
tiful supply of tasteless cereals and milk. Both these foods 
are necessary, but the diet should not consist entirely of 
them and may be as varied as desired. Plenty of cooked 
vegetables and cooked fruits are necessary, especially as 
nursing mothers are notoriously constipated. Meat can be 
eaten once a day, or twice in moderation. 



INFANT FEEDING 55 

All highly seasoned and rich foods, salads, particularly 
cabbage and onions, sour fruits, alcoholic drinks and strong 
tea and coffee should be avoided. Weak tea or coffee can be 
taken once a day, if absolutely necessary. Cocoa is the best 
beverage. Chocolate and a large quantity of milk are con- 
stipating. Sometimes it is necessary to supply fluid in some 
other form. Besides her regular meals the mother should 
drink milk when possible, especially in the middle of the 
forenoon and afternoon and at bedtime. Fluids tend to in- 
crease the quantity of milk. One glass of beer or malt 
extract sometimes acts as a slight appetizer. Meat, eggs 
and soup increase the percentage of fat, and a predomi- 
nance of vegetables and farinaceous food has a slight 
tendency to increase the carbohydrate. Everything and 
anything hard to digest, or for which the mother has an 
idiosyncrasy, should be avoided. She should guard against 
overfeeding and constipation. To relieve constipation an 
enema or a suppository is the best remedy. Castor oil 
and calomel have a tendency to upset the infant. Salts de- 
crease the quantity of milk. Drugs excreted in the milk 
which may upset the infant and are best avoided are: 
Castor oil, calomel, arsenic, aspirin, salicylic 
acid, belladonna, bromides, iodides and mercury, 
when taken over a long period or in large quan- 
tities. 
If it is necessary during the nursing period for the 
mother to take an anaesthetic, it is best to put the infant 
on a whey mixture for two or three days and then resume 
nursing. Alcohol in large quantities is regularly excreted in 
the milk. 

Care of the Breasts 

The nursing mother should take great care of the 
breasts. They should be washed with a boric solution be- 
fore and after nursing; then a strip of gauze should be put 
across them. The gauze should be renewed every day. 



$6 CARE AND FEEDING OF THE INFANT 

The mother should expel the first milk before giving the 
breast to the baby, as it often contains bacteria. 

Wetting the nipple with the mother's saliva before giv- 
ing the baby the breast is criminal. 

The breasts should be protected from cold and expo- 
sure. An extremely decollete gown should be avoided at 
this time. Chilling alters the composition of the milk and 
that is likely to upset the infant. 

The First Nursing 

Mother and child are both exhausted after the birth, 
and both require a long, restful, unmolested sleep. Usually 
for the first twelve to twenty-four hours the new-born in- 
fant sleeps peacefully and continuously, and on no account 
should it be aroused, not even to be displayed by a proud 
parent to an expectant group of relatives. The infant re- 
quires this long sleep to get accustomed to its new sur- 
roundings. During this time it requires no nourishment and 
nothing to drink. If, as it sometimes happens, the new-born 
is restless, refuses to sleep and cries, it may be given a 
little boiled water. However, all attempts to give the infant 
milk in any form should be discouraged. It requires twelve 
to twenty-four hours to whet its appetite and to get up 
ardor for the strenuous work of nursing. Under no circum- 
stances should it be put on the breast during the first 
twelve hours. The mother requires this time for rest, re- 
adjustment and recuperation. 

Milk first begins to appear two or three days after the 
birth of the infant; with first babies, even later, sometimes 
four or five days. If no milk has appeared at this time, it is a 
mistake to think that the mother will have none and to 
cease the attempt at nursing. Some women, especially with 
their first babies, do not begin to secrete milk until the 
beginning of the second week. In such cases the infant 
should be put on the breast every period, just the same, as 



INFANT FEEDING 57 

the act of sucking stimulates the production. If it cries and 
appears unsatisfied after this attempt, it should be given 
whey or an appropriately diluted milk from a bottle. 

Colestrum 

The forerunner of milk which appears in the breast and 
which can be expressed on pressure is called colestrum. It 
is often present in the milk before birth and is of a deep 
yellow color and has a salty taste. In olden times it was 
considered poisonous and not given to the baby, this de- 
duction being drawn on account of the peculiar taste and 
color. But colestrum, like everything else which Nature 
provides, has a purpose. It not only acts as a food until 
milk begins to be secreted, but it is also supposed to be a 
mild physic. Colestrum crystals persist until the eighth to 
the tenth day, when they disappear. 

Milk Fever 

White, sweet milk makes its appearance between the 
second and sixth day. Sometimes much later. Often when 
the milk begins to be secreted in quantity, the breasts 
swell and become painful. This condition, which is often 
accompanied by fever and which makes the mother ill for 
a day or two, is milk fever and should not excite alarm. In 
earlier days the nurse often weaned the baby at this time, 
believing the milk was not good. No greater mistake can be 
made. The sucking of the infant on the breast relieves the 
pressure, and though painful at times, the mother is ulti- 
mately rewarded by a plentiful supply. 

If Nature intended a quantity of milk in the first days 
there is no doubt that it would have been provided, 
but at first the infant can accommodate only small quan- 
tities. The amount gradually increases up to the sixth or 
eighth week, when a full liter is secreted. Many inexperi- 



58 CARE AND FEEDING OF THE INFANT 

enced mothers and nurses think this quantity should be 
reached much sooner. 

Because the infant cries once in a while is not a sign 
that it is hungry, has colic or that the milk is disagreeing 
with it. During the first few days it is good for a healthy 
infant to cry and expand the lungs, and if it does not, it 
should be made to do so. It takes some time for the infant 
to learn to nurse properly, and it requires considerable 
patience before the nursing progresses smoothly, but as 
future development depends on the first few days, every- 
thing should be done to keep the baby on the breast. 

Of course in these first days before the milk begins to 
flow, the baby should not be allowed to hunger. For the 
first three or four days boiled water, with or without sac- 
charin, should be sufficient, but it should not be given until 
after the infant has first been put upon the breast. After the 
fourth day something more substantial must be given, such 
as a whey-cream mixture, but always the attempt upon the 
breast must first be made. In this way many an infant has 
been saved from being put upon artificial food. 

Usually the new-born babe is not given the breast until 
the second day. Both the mother and babe require the first 
twenty-four hours to recuperate from the birth and their 
sleep and rest should be left undisturbed. On the second 
day, however, the first attempt should be made. The mother 
should lie on one side, her back supported by pillows, and 
the nurse, having washed her hands, should prepare the 
breast for nursing, by washing the nipple first with boric 
acid and then with warm water. The infant is then laid in 
the mother's arms, not obliquely across her body, but 
tangent to it, the baby's head and chest resting across one 
arm. With the other hand the mother should place the 
nipple in the baby's mouth, at the same time being careful 
to keep the breast away from the baby's nose. It is impos- 
sible for it to nurse when it cannot breathe freely. Often it 



INFANT FEEDING 59 

will make no attempt to suckle. Under these circumstances 
the nipple should be moved from side to side in its mouth, 
or the nurse should press the tiny cheeks together, in an 
effort to teach the infant how to suckle. Sometimes it is 
necessary to express a drop or two of milk before it begins 
to work. It is a bad practice to powder the nipples with 
sugar before starting the nursing; it is apt to cause an in- 
testinal upset. 

When the mother is out of bed, nursing should proceed 
as follows: She should sit in a low chair, preferably one 
without arms. One knee, by means of a footstool or other- 
wise, should be raised somewhat higher than the other. The 
infant should be laid diagonally across the mother's lap, 
the head resting on the mother's arm and higher knee; and 
with the free hand the nipple is held in position, the breast 
kept free of the baby's nose, and a slight pressure is ex- 
erted which aids the infant in suckling. If the mother 
assumes a comfortable position, she avoids the backache 
which is so frequent at this time. 

Method of Feeding 

In the beginning until the breasts are secreting an ade- 
quate amount it is necessary to give both breasts at each 
feeding, as the sucking stimulates the production of milk. 
When the baby has both breasts they are not completely 
emptied, and there is no stimulation to increase the quan- 
tity, so both should be given only in the first few days. The 
last milk is the richest in fat, and completely emptying the 
breasts each time increases the fat percentage as well as 
the total quantity. 

When the baby is weak or premature, or the breasts do 
not flow easily, it is necessary at first to express the milk by 
hand or with a pump. Pumping after the baby has finished 
is a good practice, as it increases the quantity for the next 
period, and the amount pumped can be fed with a spoon. 



60 CARE AND FEEDING OF THE INFANT 

If it is possible to obtain an older, stronger baby to nurse, 
it increases the supply. When the normal infant is satis- 
fied, it goes to sleep and it should not be forced to take more 
than it wants. 

Length of Nursing Period 

The baby should not nurse longer than fifteen minutes. 
Experiments have shown that it gets all it wants in the 
first ten minutes and very little is obtained after fifteen 
minutes. If, at the end of twenty minutes, the infant cries 
and appears unsatisfied, there is probably an insufficient 
supply of milk, and it should then be weighed before and 
after nursing to ascertain exactly how much it is getting. 
Infants who are lazy and do not work sufficiently should 
not be allowed to go to sleep before the first fifteen min- 
utes are up. During the night the mother should not give 
the baby the breast and then go to sleep. The child may 
overfeed or go to sleep with the nipple in the mouth; this 
makes it tender and may cause fissures. 

The Amount of Feeding 

The amount of milk which an infant obtains at a period 
is variable and depends upon its age and development. A 
strong infant obtains much more than a weak one. The two 
first periods in the morning supply the largest quantity. 
The mother has had a long rest, there is a plentiful supply, 
and the baby after the night's sleep is very hungry and 
works harder. 

During the twenty-four hours of the second day the 
infant averages about two to three ounces. 

By the end of the first week about eight ounces. 

By the end of the first month about sixteen ounces. 

By the end of the second month twenty to thirty 
ounces. 



INFANT FEEDING 6l 

By the end of the fifth month thirty-two ounces. 

The total amount obtained during twenty-four hours 
can be ascertained by weighing the baby before and after 
every nursing and adding the differences together. 

A good rule for determining the requirements of a 
breast infant is the following: 

In the first quarter year, an infant requires one hundred 
and fifty grams, or five ounces for every kilo of weight 
(approximately two pounds) per day. 

In the second quarter, four and two-thirds ounces per 
kilo per day. 

In the third quarter, four to four and one-third ounces 
per kilo per day. 

The normal breast-fed baby requires in mother's inilk 
in twenty-four hours one-sixth of its weight. 

Number of Feedings 

Experience and experiment have taught us that every 
three hours is often enough to give the baby the breast. 
The infantile stomach requires from two to two and one- 
half hours to empty itself, and then it needs a little rest 
before the next feeding period. An infant works better if it 
is hungry, and empties the breast more thoroughly, so the 
three-hour rule works well for the mother and child. Feed- 
ing a baby whenever it cries results disastrously. 
A good schedule is as follows: 

Morning Afternoon 

6 A. M. 3 P. M. 

9 A. M. 6 P. M. 

12 M. io P.M. 

and during the first month once during the night. At the 
end of four weeks six nursing periods are sufficient, and the 
infant has a long sleep which gives the digestion a period of 



62 CARE AND FEEDING OF THE INFANT 

rest. Often the infant is able to get along with four-hour 
periods. This is better still, and should be encouraged. This 
is only possible with a large supply of milk and a strong 
baby. The following is a good schedule for four-hour 
periods: 

Morning Afternoon 

6 A. M. 2 P. M. 

ioA. M. 6 P.M. 

ioP. M. 

When the baby is six months old, five nursing periods 
should prove sufficient. 

With premature, weak and sick infants it is necessary 
to feed smaller quantities and more often. This point 
should be left to the discretion of the physician in charge. 

Feeding should be done regularly and methodically, 
even if it is necessary to awaken a child out of a sound 
sleep. Children are creatures of habit, and it is best to begin 
early with a good organization. At first the infant sleeps 
from one period to the next, and awakens regularly by the 
clock, just three hours after the last feeding. Of course, in 
illness, when a good rest and sleep are more important than 
a feeding, an exception can be made. 

It is an extremely bad habit to inaugurate the custom 
of feeding twice during the night. Merely because the infant 
cries out once or twice is no reason to conclude that it is 
hungry; it is more often wet or uncomfortable. By encour- 
aging this broken nights rest babies get into the habit of 
sleeping well during the day and lying awake at night. 
When the infant gets into this habit, it must be broken at 
once. If it continues to cry after being made comfortable, a 
little boiled water sweetened with saccharin usually suc- 
ceeds in lulling it to sleep. After two or three nights of this 
water cure, it ceases to awaken. If it does not, a warm bath 
at bedtime makes the infant so drowsy that it sleeps until 
daybreak. 



INFANT FEEDING 63 

Great care must be exercised that the baby is not cry- 
ing from lack of nourishment. This can be settled by weigh- 
ing it before and after every feeding. If it is not making 
weekly gains it is safe to say that it is not receiving suffi- 
cient food. During the first two months a baby should gain 
five or six ounces weekly; from three to six months, four to 
five ounces weekly; and towards the end of the year, two 
to three ounces. If there are no scales handy, the follow- 
ing symptoms are a good criterion as to the sufficiency of 
the mother's milk: 

If the infant is receiving enough nourishment it sleeps 
from one period to the next, looks bright and rosy, has a 
plump body, urinates twice as often as it is fed and has two 
to three normal yellow stools daily. 

If the mother's supply of milk is small but of good 
quality, and nearly all is absorbed, the stools will be few in 
number. 

Too Much Milk 

Quite frequently it happens that a mother has too 
much milk. The infant is very uncomfortable after each 
nursing, suffers from colic, diarrhoea or constipation, regur- 
gitates, sleeps restlessly, cries a great deal and wets many 
diapers. In these cases the mother should drink during the 
day as little fluid as possible, and the infant should be al- 
lowed to nurse only six to seven minutes instead of fifteen 
to twenty minutes. Many of these regurgitating, colicky 
infants are taken from the breast and put on the bottle 
because the mother does not think the breast milk is agree- 
ing with the baby, when all that is required is to regulate 
the amount at each nursing. In these cases it is absolutely 
necessary to have scales to check one's observations. 

Too Little Milk 

If the mother has too little milk the infant frets con- 
tinuously, is pale and weak, sleeps from weakness on the 



64 CARE AND FEEDING OF THE INFANT 

breast, does not gain in weight, wets few diapers and has 
brownish stools, or no stools at all. For this condition the 
mother should drink at least a quart of fluid daily, prefer- 
ably milk and soup. Often malt, in one form or another, 
has a good effect. Before and after each nursing the breasts 
should be lightly massaged, preferably toward the nipple. 
The best results are obtained when the breasts are emptied 
after each feeding. Quite often this deficiency of milk is due 
to the fact that the infant is not strong enough to empty 
the breast each time. In these cases the breast must be 
emptied after each period either by hand, breast pump or 
another stronger infant, Remarkable results are obtained 
by this emptying of the breast completely. Massaging and 
pumping of the breast by hand must be done very care- 
fully, as there is danger of injuring the sensitive mammary 
gland. 

Injury to the Breast 

Unless the prospective mother has taken some care in 
preparing her breasts for nursing before the advent of the 
baby, the nipples are apt to suffer. This is especially the 
case when the baby grapples only the nipple without any 
of the surrounding breast tissue. At times they become so 
sensitive and fissured that the mother fears the nursing 
period. These nipples should be protected with a shield and 
the fissures require treatment with tannin and alcohol. If 
the fissures are neglected an inflammation or mastitis of the 
breast is apt to result with fever and frequent chills. On 
account of the great pain many mothers give up nursing on 
the affected side. This is a bad practice both for the baby 
and for the mother. If the mother does not nurse on the 
affected breast it becomes much more congested with milk, 
increasing the pain and inflammation, so it is better for 
the mother to exert all her will power and nurse the baby. 
The milk does the infant no injury. The affected breast 
should be under the care of a physician continuously. 



INFANT FEEDING 65 

Wet-Nursing 

If the mother can not nurse her babe and can afford it, 
it is better to resort to a wet-nurse. There is no foundation 
for the impression that the wet-nurse's baby must be the 
same age as the other infant. The only thing to guard 
against in such circumstances is, if the infant is very young 
and the wet-nurse has a large supply of milk, that it does 
not overfeed. Another danger lies in the fact that if the 
wet-nurse is not nursed dry, her milk will begin to dis- 
appear. On this account and on account of the high mor- 
tality among babies of wet-nurses, it is better to take both 
the mother and her child. The wet-nurse's infant can have 
the breast after the other baby has been sufficiently fed. 
Most wet-nurses can supply milk for two infants. Demand 
creates supply in breast milk more than in any other com- 
modity. If the wet-nurse is separated from her baby, she 
is often in an excitable condition, which is bad for her milk. 

Before a wet-nurse is engaged both mother and child 
should be subjected to a complete examination from head 
to toe, and one must be careful that another infant is not 
substituted. The physician should determine whether the 
mother is in absolutely good physical condition, and the 
breasts should be examined to determine whether there is 
a good supply of milk. She should be examined particularly 
for evidence of tuberculosis, syphilis, gonorrhoea, contae- 
gious diseases and vermin. 

The nurse's baby should be examined to see whether it 
is absolutely healthy and that it is not tainted with heredi- 
tary diseases. 

After the nurse has been examined and found healthy 
she should have a bath and a fresh supply of garments be- 
fore handling the infant. She should follow the same pre- 
cautions as the mother. 

The wet-nurse, though a very important personage, 
should not be pampered. Her diet should consist of the 



66 CARE AND FEEDING OF THE INFANT 

things to which she is accustomed. She should have a 
moderate amount of work to do, and should exercise daily 
in the open air. A too great change in mode of life, work 
and food often results in her milk drying up, or at least 
disagreeing with the infant. 

The care of the child should be carried out exactly as if 
it were on the mother's breast. During the first few days 
it should be weighed before and after nursing to be sure 
that it is getting enough and not too much. 

Feeding of the Breast-Fed Infant 

After the First Six Months and Between 

the Sixth and Seventh Months 

The breast-fed baby requires additional food. It has 
been found that infants that are fed exclusively on the 
breast do not flourish as they should. They become pale, 
constipated and sometimes "cranky" or apathetic. This is 
due in part to a deficiency of iron. The full-term baby 
comes into the world with a depot of iron which is said to 
be stored away during the last days of pregnancy. At the 
end of six months this supply is exhausted; milk being very 
poor in iron does not keep it up, and it has been found that 
the above symptoms disappear on giving food rich in iron. 
So the breast-fed baby requires certain things from the 
seventh or eighth month on. 

Fruit juice is the first requirement. It can be given in 
small quantities two or three times daily. It is best to begin 
by giving one teaspoonful immediately before the bath. 
This quantity can be increased gradually up to one ounce. 
Orange juice is undoubtedly the most satisfactory to give; 
if oranges are difficult to obtain the juice from an apple or 
apple sauce proves satisfactory. The juice of almost any 
fruit but strawberries can be used; strawberries have an 
idiosyncrasy for many people and cause urticaria. 



INFANT FEEDING 67 

Besides the fruit juice, soup or beef juice and a vege- 
table are required. The midday nursing period can be sub- 
stituted for one of soup or beef juice and vegetable. The 
soup, preferably chicken, pigeon, beef or mutton, should be 
thoroughly cooked and strained and about five ounces 
given. After the soup two teaspoonfuls of spinach or carrot 
puree may be given. This quantity can be increased later. 
Spinach is especially to be recommended, as it is very rich 
in iron. Frequently mothers complain because spinach ap- 
pears to them undigested in the stool, but the valuable part 
of the extractives has been absorbed. 

Sometimes the meat-broths do not agree with an infant. 
The baby reacts with diarrhoea or lichen urticatus. In 
these cases a meal soup prepared as follows can be given: 

One level tablespoonful of oats or barley meal is cooked 
with a little butter, salt, and sometimes sugar, in a pint of 
water. The mixture should be thoroughly cooked for thirty 
minutes, until about one-half of the original amount of 
fluid remains. Milk can be used instead of water. 

After the teeth come the infant can be given a piece of 
zwieback to nibble on. Great care must be taken that it 
does not choke. 

Weaning 

Between the ninth and twelfth months the infant should 
be weaned. It is better to avoid weaning during the sum- 
mer, so it may be necessary to keep up the nursing over 
this time. The weaning should be done gradually, one 
period at a time being substituted for the bottle. The first 
bottle should be given for a week, then a second period 
substituted, etc.; three to four weeks should be taken in the 
process. If the baby is of normal weight and is about nine 
months old it can be given a seven or eight ounce mixture, 
two-thirds certified milk and one-third boiled water, or 
better still, oatmeal or barley water. The preparation of 



68 CARE AND FEEDING OF THE INFANT 

this mixture will be found elsewhere in this book. It can 
gradually be increased to full milk. 

Eggs should not be given during the first fifteen months. 
They are the chief cause of lichen urticatus. When eggs 
are given the yolk is the preferable part. It can be cooked 
and stirred into the soup and given at midday. 

Schedule for Breast-Fed Baby in 
Seventh Month 

6:00 A. M.— Breast. 

8:45 A. M. — Orange juice, teaspoonful— increased gradu- 
ally to one ounce at first year. 

9:00 A. M— Breast. 
12:00 M. — Soup, four or five ounces; or beef juice, one 

ounce. 
3:00 P. M— Breast. 
6:00 P. M— Breast. 
9-10 P. M.— Breast. 

Schedule for Ninth and 
Tenth Months 

6:00 A. M. — Breast. 
8:45 A. M. — Orange juice, one ounce. 
9:00 A. M. — Breast. 
12:00 M. — Soup, four or five ounces; or beef juice, one 

to two ounces. 

Spinach or carrot or potato puree — at first 

three to four teaspoons (gradually increase). 

Apple sauce, two or three teaspoons. 

3:00 P. M— Breast. 
9:00 P.M.— Breast. 



INFANT FEEDING 69 

Schedule from Tenth to 
Twelfth Month 

(Following the Weaning of the Baby) 

6:00 A. M. — Farina (see directions), two to three ounces 
with a little milk and sugar. 
Milk, four or five ounces in bottle. 

8:45 A. M. — Orange juice, one ounce. 
9:00 A. M. — Bottle, seven ounces. 
12:00 M. — Soup — mutton, beef, veal, chicken or pigeon 

— with a little rice or barley or well-cooked 

farina added. 

Puree of spinach, carrots, potato, cauliflower 

blooms, five or six teaspoons. 

Apple sauce, scraped prunes, four or five 

teaspoons. 

Bottle, three to four ounces, if necessary. 

3:00 P. M. — Bottle, seven ounces. 
6:00 P. M. — Bottle, eight ounces. 

When the baby is weaned it is always advisable to be- 
gin with a dilution intended for a much younger infant. 
After the weaning is completed, then the strength of the 
mixture should be increased to age and body requirements. 
In this way there is much less opportunity of completely 
upsetting the infant. 

Breast and Artificial Feeding Combined 
Mixed Feeding 

Often it happens that the mother has not enough breast 
milk to nurse her infant successfully. In these cases both 
breast milk and milk from the bottle should be given. The 
mother should be encouraged at any rate to keep her baby 



70 CARE AND FEEDING OF THE INFANT 

absolutely on the breast for the first three months. It gets 
a start in life this way which can not be made up in any 
other. Further, it has been proved that the infant can not 
handle carbohydrates in any quantity until after the third 
month; so the mother should do everything possible to aug- 
ment the supply of her milk; this can be influenced to some 
extent by drinking large quantities of fluid. 

After the third month if her supply is not sufficient the 
difference can be made up with a cow's-milk mixture. Un- 
der no circumstances should the infant be totally weaned. 
When the mother's supply is not sufficient there are two 
methods of procedure: One is to alternate breast and bot- 
tle feedings, and the other is to make up with the bottle the 
deficiency obtained from the breast. 

In the latter method proceed as follows: 

The infant should be weighed and then allowed to 
nurse. After the nursing it should be weighed again to 
ascertain the amount it has obtained. When the quantity 
is insufficient it should be made up with a feeding from the 
bottle, the formula corresponding to the age and needs of 
the infant. Artificial feeding should always be made as diffi- 
cult as possible, otherwise the infant soon learns that it is 
easier to drink from the bottle than to nurse from the 
breast; on this account a nipple with a very small hole 
should be used and the infant compelled to drink slowly. 

When the breast and bottle alternate it is best to start 
the first feeding on the breast, give the second from the 
bottle, and so on during the day. The formula used here 
should likewise correspond to the age and requirements of 
the infant. 

The day's schedule should be arranged as follows: 
6:00 A. M— Breast, left. 
9:00 A. M— Bottle. 
1 2 :oo M. — Breast, right. 
3:00 P. M— Bottle. 



INFANT FEEDING 71 

6:00 P. M. — Breast, left. 
10:00 P. M. — Breast, right. 
Often it is sufficient when only one bottle is given. This 
is best given at noontime and at first the effort should be 
made to get along with one substitution. 

Artificial Feeding 

By artificial feeding of infants we mean feeding with 
food other than breast milk. For this purpose either cow's 
or goat's milk is used. It should only be resorted to when 
the mother is too ill to nurse, when she has not milk enough 
or none at all, when it is impossible to have a wet-nurse or 
when for some reason or other it is necessary for mother 
and child to be separated. There is no question but that 
breast milk is the food for the infant, and as before stated, 
not only do breast-fed babies thrive better and develop 
stronger, but their resistance against infection is superior 
to artificially fed ones. So the weaning of the baby should 
be deferred and the mother should make every effort to 
nurse her infant, if not for nine months, for as long a time 
as possible; three months of breast feeding gives an infant 
a start it can obtain in no other way. Of course there are 
many babies who develop into a healthy childhood on arti- 
ficial food, but these are the youngsters with such strong 
resistances and constitutions that they would thrive any- 
way. It is a fact that the majority of babes who succumb 
to one complaint or another are bottle-fed. 

In breast milk the infant receives a fresh, untainted 
food at body temperature which Nature intended for the 
weak digestion of a baby, and through the strenuous work 
of nursing the gradually wearying infant is prevented from 
over-feeding. 

The artificially fed infant receives a food intended for a 
totally different organism. It is harder to digest, never ab- 
solutely fresh, and is apt to be infected through handling. 



J2 CARE AND FEEDING OF THE INFANT 

The infant does not have to work for artificial food, con- 
sequently the digestion is not prepared and stimulated as 
is the case when nursing from the breast; and since the 
infant does not tire so rapidly, overfeeding, with indiges- 
tion, colic, etc., are likely to result. 

In some ways goat's milk is better than cow's milk. It 
is practically tuberculosis free, and is not subject to infec- 
tion with typhus and diphtheria bacilli. However, in the 
city it is almost impossible to get goat's milk and when we 
speak of artificial food it almost always means cow's milk. 

Requirements of Good 
Cow's Milk 

The milk must come from healthy cows. It must be 
fresh, clean, undiluted, unskimmed and must contain no 
preservatives and no pathogenic organisms and at least 
three per cent fat; this is a law in Germany. 

The cows must be free of tuberculosis, especially the 
udders; there must be no inflammation about them, no in- 
testinal catarrh, foot and mouth disease, glanders or an- 
thrax. They must be kept in clean, airy stalls and should 
spend part of each day in the open air. They should not be 
fed entirely on dry fodder; it makes the percentage of fat 
too high; neither must they be fed entirely on green alfalfa 
or grass. It is apt to cause colic and diarrhoea in babies. 
The milk must come from a herd of cows and not be con- 
fined to one, and the animals must be examined every once 
in a while by a veterinary. 

It is also necessary that the personnel of the dairy keep 
their hands absolutely clean, and they must be free of all 
diseases, especially infectious in nature. 

As soon as the cow is milked the milk should be strained 
and immediately cooled, so as to hinder the growth and 
further development of bacteria. The best milk to use is the 



INFANT FEEDING 73 

so-called certified. There is no likelihood of preservatives 
being used, and it is not falsified, that is, diluted with water 
or skimmed milk. Certified milk is so obtained that the 
number of bacteria are limited. In ordinary milk that one 
buys at a grocery there are 100,000 bacteria to the c. cm. 
In certified milk there are about 10,000 and it is possible to 
obtain it with only 200 to the c. cm. 

When milk is delivered to the house the main thing is 
to keep it cool enough to prevent the bacteria from multi- 
plying. For this purpose it should be put in the ice-chest or 
kept in a basin filled with cold water, which should be 
changed frequently. In feeding young infants, unless one is 
absolutely sure of the milk it is better either to boil, steril- 
ize or pasteurize it. 

Boiling the Milk 

A special double boiler should be provided for this pur- 
pose. The required amount for the day is then boiled for 
fiVQ minutes and is cooled as rapidly as possible. It is best 
cooled and preserved in the same utensil in which it was 
boiled; then there is no chance of its becoming reinfected 
through handling. This can be done by cooling it with ice 
or cold, running water. 

Boiling the milk makes many changes in its composi- 
tion. Certain natural ferments, believed to be of value in 
digestion, are destroyed, part of the lactose is turned into 
caramel, the lactalbumen is partially coagulated, it be- 
comes more difficult for the rennin to coagulate the casein, 
organic phosphorus is changed into an inorganic phos- 
phate, a volatile sulphide is liberated which shows evidence 
of a change in proteids, and several salts which are usually 
soluble are rendered insoluble. 

Moreover, there are clinical reasons which make one 
believe that the nutritive properties of milk are impaired 



74 CARE AND FEEDING OF THE INFANT 

by heating, and these are the occurrence of scurvy and 
rickets in infants who are fed upon boiled milk for any 
length of time. Boiled milk predisposes to constipation and 
should only be resorted to temporarily. 

Sterilizing 

Sterilization is the term used to designate the heating 
of milk for the destruction of bacteria. However, it should 
be understood that sterilizing milk, while it destroys the 
greater number of the bacteria, still leaves the spores, 
which develop under favorable circumstances. It is on this 
account that after milk is sterilized or boiled it should be 
rapidly cooled to prevent further development of the 
spores. Bacteria cannot develop in the cold. 

Soxhlet inaugurated sterilizing of milk in 1886 and pro- 
vided an apparatus for this purpose which is used to the 
present day and which cannot be improved upon. He 
recommended that the sterilization should continue under 
pressure at 21 2° F. for one and one-half hours. This, how- 
ever, is not required. All that is absolutely necessary is to 
fill the bottles for the day with the required number of 
ounces; they are then stoppered with a special rubber cap 
or cotton, and are fitted into a tray with a perforated bot- 
tom. This tray then fits into a tin boiler with a cover. After 
the bottles are in place the boiler should be filled with cold 
water up to the level of the mixture and the lid fitted on. 
Now the water is allowed to boil for five minutes; this ex- 
poses the bottles on all sides to live steam. 

After five minutes are up the milk must be rapidly 
cooled, best by allowing cool water to run into the hot 
water; this prevents the bottles from cracking. After the 
bottles are cooled they must be kept in a cool place until 
desired for use. Immediately before giving the bottle to the 
baby the milk should be heated to a lukewarm temperature, 
as cold milk is apt to cause colic. 



INFANT FEEDING 75 

Pasteurization 

In order to avoid the chemical changes brought about 
by boiling the milk, but still to destroy the bacteria, it is 
possible to pasteurize it. By this process the milk is heated 
for one-half hour at a temperature of 1 55°. This destroys 
most of the germs, and by rapidly cooling it the rest of the 
bacteria are prevented "from developing. 

Boiling, sterilizing and pasteurizing destroy many of 
the properties of milk which make it valuable as a food. 
Not only is the milk changed chemically but it predisposes 
to the development of scurvy, so there is no question but 
that raw milk is the most satisfactory, and if it is possible to 
obtain a good certified milk free from pathogenic bacteria 
and especially of tuberculosis, it should be used. But for the 
great masses certified milk is too expensive, so when neces- 
sary to use ordinary milk it should always be boiled, steril- 
ized or pasteurized. Pasteurized milk should be cooled 
rapidly in cold water, never by placing on the ice; it takes 
too long to cool — at least one and one-half hours. 

Bottles and Nipples 

It is necessary to keep all the utensils which come in 
contact with the infant absolutely clean and steril. The 
most desirable baby bottles are round and have the ounces 
marked off on the sides. They are the easiest to keep clean, 
and it is possible to keep an exact account of the number 
of ounces which the infant drinks. After being used the 
bottles should be immediately cleaned with hot water; at 
least they should be filled with cold, to prevent the milk 
from drying in them. Before being rinsed they should be 
thoroughly cleansed with a brush and hot soda solution; 
then they should be rinsed in boiling water and turned up- 
side down to drain. 

The nipples are made of rubber and after being used 
should be rinsed inside and out with tap water. They should 



j6 CARE AND FEEDING OF THE INFANT 

be boiled at least once a day and taken out of the boiling 
water with pincers and dried with a cloth. They should 
be kept dry in a covered dish or kept covered in a boric 
solution, from which they are taken and thoroughly rinsed 
out before being used. 

When a new nipple is to be used the hole should be 
burnt in it with a hot needle. The size of it should be regu- 
lated according to the consistency *of the food — small for 
water, large for thin gruels. It should not be made too 
large, otherwise the infant drinks too rapidly and is apt to 
have colic or regurgitate. 

Rules for Feeding 

Periods: With bottle-fed babies it is just as important 
to have long periods between feedings as with the breast 
ones. It requires longer for the infant's stomach to empty 
itself of the more indigestible cow's milk than breast milk. 
In the first four weeks the periods must be at least three 
hours apart, as follows: 

Six, nine and twelve A. M.; three, six and nine P. M. 
and once during the night. 

If possible four-hour periods are better: 

Six and ten A. M.; two, six and ten P. M. 

The infant should have a long rest at night, preferably 
for six or eight hours. Before giving the bottle it should be 
heated to body temperature. One must be careful that it is 
not too hot, as it is apt to burn the infant's mouth; there- 
fore, it should be tested before being given. If it is not found 
too hot for the eyelid or cheek, it is about right for the 
infant. The temperature should never be tested by sucking 
on the nipple. To prevent the milk from becoming too cool 
the bottle should be wrapped in a woolen cloth, and heated 
once or twice during the feeding. 

When the bottle is ready the infant should be laid on its 
side and the nurse should hold the bottle. She should never 



INFANT FEEDING 77 

prop it up on a pillow and go off and leave the baby to 
drink by itself. It is contraindicated from many stand- 
points. The infant is apt to choke on the nipple, or it is apt 
to slip so deep in the throat that it excites vomiting or 
regurgitating, or the infant is apt to drink the bottle dry 
and then continue to swallow air, which is one of the chief 
causes of colic, or it is apt to lose the nipple from its mouth 
and the nurse find the cold bottle untouched by the baby's 
side. If the bottle is reheated, valuable time is lost and the 
period until the next feeding is shortened. Or the milk 
may leak into the bed and then it is impossible to say how 
much the infant has obtained. Sometimes the baby goes to 
sleep and the milk continues to flow. It may be inspired 
into the lungs and result in a fit of choking. 

Weak infants require continual encouragement to make 
them drink. 

The diapers should always be changed immediately be- 
fore the infant is fed, not after, as handling at this time 
often causes regurgitation. 

The infant should not be allowed to drink longer than 
twenty minutes, nor for less than fifteen minutes. Some- 
times it will not drink until the nurse presses the sides of 
the nipple together and so squirts some of the warm fluid 
into its mouth. The nipple must never be moistened in the 
nurse's mouth. 

After the infant has finished feeding it should be 
held up for a moment in the nurse's arms until it belches 
whatever air it has swallowed during the sucking. This pre- 
vents colic and regurgitation. 

Whatever milk the baby leaves in the bottle should be 
thrown away and not used again. 

If milk is to be carried on a journey not longer than ten 
hours the required amount should be heated and carried in 
a sterilized thermos bottle. After ten hours the milk should 



78 CARE AND FEEDING OF THE INFANT 

not be used. If sterilized milk is kept on ice it will keep for 
two or three weeks; pasteurized for two or three days. 

The artificially fed infant should be weighed twice a 
week, so that the nurse or mother is able to tell whether it 
is gaining sufficiently on the formula and to compare it 
with the weight of a normal baby of the same age. The 
weighing should always be done at the same time of day 
and under the same conditions, preferably just before the 
morning bath. However, whether the infant is gaining is 
not the only and most important sign of its thriving. The 
development of the functions of the body, sitting up, 
standing, walking, its general appearance, the color and 
demeanor are more important. The chief thing that con- 
cerns the mother is whether the infant gains, and the most 
important thing which delights the physician is whether 
the baby is lively, whether the color is good and whether it 
learns to stand and to walk at the proper time. 

Preparation of Artificial Food 

No two babies can be fed alike and no baby can be fed 
by a scheme or by age or by what some other infant throve 
on. The physician in charge should make a study of every 
individual case, and should feed it by requirement and by 
body weight. It has been found that every infant, in order 
to gain, requires after the first three weeks and during the 
next three months approximately ioo calories per kilogram 
body weight. Some infants do not digest fat well, some get 
in trouble with the carbohydrate, so that every infant re- 
quires individual study and treatment. As one author has 
said: "A ready-made formula does not succeed with the 
average baby any more than ready-made clothes fit the 
average man." They all require taking in here or letting 
out there, and the same is true of the formula. That is why 
the mother should consult a reputable physician often, so 
that he may become familiar with the baby and meet 



INFANT FEEDING 79 

requirements as they arise. She should never follow the 
advice of some old friend or nurse or the directions which 
come with prepared foods. There is no doubt that the 
feeding infant should be under the care of a physician at 
least during the first year, and he should see the infant at 
least once every two weeks. Most mothers do not know 
when rickets, scurvy or intestinal diseases are developing 
until it is too late and the baby requires long months of 
treatment to restore it to a normal condition. 

Most infants can not digest whole cow's milk and it has 
to be modified, and the younger the infant is, the more 
modification the milk requires, and the sugar must be 
added to bring the percentage of carbohydrate up to that 
found in mother's milk. 

In the first two or three weeks the cow's milk should be 
diluted with boiled water, to which the desired amount of 
sugar has been added. 

After the third month it is advisable to dilute the milk 
with a very thin oatmeal or barley water, which increases 
the value of the mixture as a food. Before the end of the 
third month it is not to be recommended, as it has been 
found that up to that time the infantile digestion can not 
take care of large quantities of starch, so purposely the oat- 
meal and barley water is made thin at first. After three 
months it should be prepared with one rounded tablespoon 
of oatmeal or barley, and cooked in one pint of water for 
one hour. At the end of that time boiled water should be 
added to make up for the evaporation and the mixture 
strained. 

If for any other reason it is impossible for the baby to be 
fed on the breast and it is necessary to begin immediately 
with artificial feeding, it is wise to choose a very weak milk 
modification or a whey formula. The directions for the 
preparation of whey will be found elsewhere in this book. 
During the first day, as before stated, nothing is required. 



8o- 



CARE AND FEEDING OF THE INFANT 



Beginning with the second, small amounts of a milk-water 
or a whey-milk mixture can be given and the following 
scheme may be followed: 





No. and quantity 


Total 


Preparation of 




Age 


of each feeding 


quantity 


mixture 


Sugar 


2 day 


7 fdgs. of y 2 oz. 


l z / 2 oz. 


Whey 




3 day 


7 fdgs. of 1 oz. 


7 oz. 


Whey 19 oz., whole milk 1 oz. 




4 day 


7 fdgs. of I to 1^4 oz. 


10Y 2 oz. 


Whey 19 oz., whole milk 1 oz. 




5 day 


7 fdgs. of 1^4 oz. 


10^ oz. 


Whey 19 oz., whole milk 1 oz. 




7 day 


7 fdgs. of 2 oz. 


14 oz. 


Whey 18 oz., whole milk 2 oz. 




14 day 


7 fdgs. of 3 oz. 


21 OZ. 


Whey 17 oz., whole milk 4 oz. 




3 & 4 week 


7 fdgs. of 3 oz. 


21 OZ. 


B. wr. 14 oz., w. m. 7 oz. 


I oz. 


2 month 


7 fdgs. of 4-4^ oz. 


32 OZ. 


B. wr. 18 oz., w. m. 14 oz. 


I oz. 


3 month 


7 fdgs. of 4^ oz. 


32 oz. 


B. wr. 16 oz., w. m. 16 oz. 


iVs OZ. 


4-6 month 


7 fdgs. of S^-6-oz. 


42 oz. 


0. wr. 18 oz., w. m. 24 oz. 


l J / 2 oz. 


7-9-month 


6 fdgs. of 7 oz. 


42 oz. 


0. wr. 12 oz., w. m. 30 oz. 


i x / 2 oz. 



Abbreviations- — B. wr., boiled water 3 w. m., whole milk 5 0. wr., oatmeal water. 

From the tenth month on, the infant should be gradu- 
ally accustomed to whole milk so that by the end of the 
twelfth month it is unnecessary to dilute it further. 

Instead of using whey-milk formulas during the first 
two weeks, simple milk and water dilutions may be used: 



Age 


No. and quantity 
of each feeding 


Total 

quantity 


"Preparation of 
mixture 


Sugar 


2 day 

3 day 

4 day 
7 day 

14 day 


7 fdgs. of y 2 oz. 

7 fdgs. of 1 oz. 

7 fdgs. of 1 r / 2 oz. 

7 fdgs. of 2 oz. 

7 fdgs. of 2^2 to 3 oz. 


lV 2 oz. 

7 oz. 
10 oz. 
14 oz. 

21 OZ. 


B. wr. 18 oz., w. m. 2 oz. 
B. wr. 18 oz., w. m. 2 oz. 
B. wr. 17 oz., w. m. 3 oz. 
B. wr. 16 oz., w. m. 4 oz. 
B. wr. 14 oz., w. m. 6 oz. 


I oz. 
I oz. 
I oz. 
I oz. 
I oz. 



Abbreviations — B. wr., boiled water 5 w. m., whole milk. 

Simple schemes for feeding in the first months: 

First day — nothing. 

From second day on — 6 to 7 feedings — 1-3 milk; 2-3 
water; 1-2 teaspoon sugar to each feeding. 

From second month on — 6 to 7 feedings — 1-2 milk; 1-2 
water; 1 level teaspoon sugar to each feeding. 



INFANT FEEDING 8 I 

From sixth month on — once soup and vegetable; 6 
feedings — 2-3 milk; 1-3 oatmeal water; 1 level teaspoon 
sugar to each feeding. 

From ninth month on — once soup and vegetable; once 
cooked meal and milk; four times full milk. 

Scheme for the amount of each feeding from first day to 
ninth day: 

First day — nothing. 

Second day. . .6 feedings x 10 grams (1-3 oz. or 1 table- 
spoon). 

Third day. . . .6 feedings x 20 grams (2-3 oz.). 

Fourth day. . .6 feedings x 30 grams (1 oz.). 

Fifth day 6 feedings x 40 grams (1 1-3 oz.). 

Sixth day 6 feedings x 50 grams (1 2-3 oz.). 

Seventh day. .6 feedings x 60 grams (2 oz.). 

Eighth day. . .6 feedings x 70 grams (2 1-3 oz.). 

Ninth day. . . .6 feedings x 100 grams (3 1-3 oz.). 

Scheme for the mixture: 

It is much better to underfeed a baby than to over- 
feed it, and at no time during the first one-half year should 
the total quantity of milk which an infant receives in 
twenty-four hours exceed one quart. Too much fluid results 
in distention of the stomach. It should never exceed one- 
sixth of the total body weight in grams, and the amount of 
milk should not exceed one-tenth. According to this rule an 
infant weighing thirty-six hundred grams (approximately 
seven and one-quarter pounds) should receive three hun- 
dred and sixty grams of milk (or twelve ounces) diluted 
with oatmeal gruel or barley water up to six hundred grams 
(twenty ounces), one-sixth body weight. 

Pfaundler of Munich formulated the following rule for 
the artificially fed baby between two and six months, 
which is very practical: 

1-10 of the body weight in grams in fresh milk. 
1-100 of the body weight in sugar. 



82 CARE AND FEEDING OF THE INFANT 

Dilute up to one quart with barley or oatmeal water 
and divide into six bottles. 

Sugar 

Of the sugars, cane and milk sugar are the cheapest, 
and therefore the most frequently used. Milk sugar, or 
lactose, is the same sugar that is found in mother's milk. 
However, it ferments very easily and is often troublesome 
on that account. Cane sugar is sweeter than milk sugar 
and ferments less easily. Both are disaccharides. 

The maltose preparations are the best to use. They fer- 
ment less easily, are more easily digested and prevent 
constipation. 

Prepared Foods 

It is better to avoid all prepared foods. Certified milk, 
sugar, one or two cereals and vegetables are all that we 
need to insure the thriving and development of the infant. 
The prepared foods never prove satisfactory substitutes 
for the products of nature. Condensed milk is especially to 
be avoided. It is adapted for sea trips or long journeys or 
for places where it is impossible to obtain a fresh supply of 
milk, but it is not adapted for continuous feeding. Many 
children apparently thrive on it — that is, they are fat and 
white, but not an ideal picture of health. A large number 
are affected with chronic affections such as rickets. 

The Pacifier 

Many nurses and mothers in the pauses between feed- 
ings give their charges a rubber nipple to suck upon. This 
is a habit which is best avoided. The pacifier is difficult to 
keep absolutely clean. It rolls on the floor and the careless 
attendant, without washing it off, gives it to the baby 
again. In this way it is easy for the mouth to become in- 
fected. The babies addicted to the pacifier swallow great 



INFANT FEEDING 83 

quantities of air and suffer from colic. However, the pacifier 
is to be preferred to the habit of sucking on the thumb or 
one of the fingers. The finger or the finger nail becomes 
deformed in one way or another, and several authors have 
claimed that it has resulted in an irregularity in the growth 
of the teeth. 

Crying After the Bottle 

Because a baby cries on finishing the bottle is not al- 
ways a sign that it is hungry; almost all bottle-fed babies 
do. The breast baby at the end of twenty minutes' nursing 
is so tired that it goes right to sleep; not so the artificially 
fed. Drinking from a bottle does not tire it out and the 
infant realizes only that the supply is exhausted, never 
that it is satisfied. So the fact that it cries should not 
make the parents think that it is unsatisfied. 

It is much better to have the infant under the care of a 
physician than to try following written formulas, as milk 
has to be especially modified for every infant. 

During the first few days as noted in the scheme, the 
infant is satisfied with small quantities. During the whole 
twenty-four hours it will not drink more than two or three 
ounces. The amount increases gradually so that by the end 
of the second week it drinks at each period between two 
and three ounces. As the baby grows older it has an in- 
creased capacity and requirement, so the amount should 
be gradually increased from time to time, but never when 
it is making daily gains and appears satisfied, and never 
because it is a week older or because it is written on the 
table. After the first three or four days the number of feed- 
ings should be increased to seven, one every three hours. 
The amount should be gradually increased in accord with 
the desires of the infant. Finally its capacity will be 
reached, usually at the end of the first month, when the 
amount averages between four and five ounces. After this 



84 CARE AND FEEDING OF THE INFANT 

time the total quantity is not increased, but the concentra- 
tion, so that by the tenth or twelfth week the infant is 
receiving one-half milk and one-half water and one tea- 
spoon sugar at each feeding. From this time no change 
should be made without an indication — that is, if the baby 
ceases to gain or seems fretful after the bottle. 

When the infant has reached the age of two months it 
should have a teaspoon of orange or tomato juice before 
the morning bath, and during the seventh month the mid- 
day bottle, completely or in part, should be substituted 
by broth — chicken, veal, beef or mutton, prepared accord- 
ing to directions found elsewhere in this book, If desired two 
or three ounces of the milk mixture may be given after the 
soup, or the bottle usually given at that time may be 
divided among the other feedings so that the infant re- 
ceives just as much milk in the twenty- four hours. Between 
the ninth and tenth months mixed food should be given. 
In the morning for breakfast the infant should have a small 
plate of farina or well-cooked oatmeal, followed by the 
bottle; at noon the soup, followed by two or three teaspoons 
of a vegetable puree and one or two teaspoons of apple 
sauce, so that the diet between the ninth and tenth months 
should be as follows: 
6 :oo A. M. — Farina, 2 or 3 ozs. with milk and a little sugar. 

Bottle of milk, 6 to 7 ozs. 
Before the bath — Orange or tomato juice, 1-2 oz. 
9:00 A. M— Bottle. 
12:00 M. — Soup — veal, mutton, beef, chicken — 4 to 5 

ozs.; or beef juice, 1 oz. 

Vegetables — spinach, carrot or cauliflower 

puree — 2 or 3 teaspoons. 

Apple sauce, 1 to 2 teaspoons. 

Bottle if desired. 
3:00 P. M— Bottle. 
6:00 P. M. — Bottle and cereal or milk toast. 



INFANT FEEDING 85 

At the twelfth month the infant should be on whole 
milk and the diet from the twelfth to the fifteenth month 
as follows: 
6:00 A. M. — Breakfast — cereal; bottle of milk. 
9:00 A. M. — Bottle. 

12:00 M. — Soup, with addition of well-cooked rice, bar- 
ley or farina, 5 to 6 ounces. 
Or beef juice, 1 to 2 ounces. 
Vegetables: potato puree, spinach or carrot 
puree. 

Fruit: apple sauce, baked apple or mashed 
prunes. 
3:00 P. M — Bottle. 

6:00 P. M. — Supper — a little well-cooked cereal, 2 to 3 
ounces. Custard pudding, junket. 
Zwieback prepared according to directions. 
Milk. 
From the eighteenth to the twentieth month, five feed- 
ing periods in the course of the day are sufficient. Three of 
these should be larger than the other two, so that at this 
age the child begins with breakfast and ends up with sup- 
per. Eggs may be given at this time, but preferably the 
yolk; it may be stirred into the soup or given at supper 
time with bread crumbs. At noontime scraped beef may be 
given, prepared as directed. A good schedule for this is as 
follows : 
7:00 A. M. — Breakfast — cereal, well cooked; milk; zwie- 
back, one piece. 

1 ounce of orange juice before morning bath. 
10:00 A. M. — Bottle of milk. 

12:00 M. — Dinner — soup, 6 to 7 ounces, with addition 
of well-cooked pieces of vegetables, rice, bar- 
ley, squares of toast or yolk of an egg. 
Scraped beef, chop or steak prepared accord- 
ing to directions. 



86 CARE AND FEEDING OF THE INFANT 

Vegetables: spinach or carrot puree; sum- 
mer squash; blooms of cauliflower; string 
beans; cooked lettuce. 

Potatoes — pureed, baked, boiled, thoroughly 
mashed. 

Dessert: apple sauce, baked apple, mashed 
prunes. 

4:00 P. M.— Bottle of milk. 

6:00 P. M. — Supper — well-cooked cereal; milk toast; milk 
custard; floating island; rice, with additions 
of cooked fruit or fruit juices. 
Bottle of milk. 

At two years the daily schedule would be as follows: 
Breakfast: Cereal with sugar, salt and a little milk. 

Or soft-boiled egg with dried bread crumbs, 

three times a week. 

Crisp bacon once a week. 

Stale bread and butter or zwieback. 

10:00 A. M. — Orange juice, 2 ounces. 

Dinner: Soup, as previously directed, with additions 

of barley, rice, yolk of an egg y vegetables, 
etc. Or beef juice, 1 to 2 ounces. 
Meats: lamb chops, steaks, roast beef, white 
meat of chicken or turkey, scraped or cut 
into very small pieces. 

Vegetables: Spinach, carrot, cauliflower, let- 
tuce or peas pureed. String beans, ends of 
asparagus and artichoke, potato or rice, all 
thoroughly mashed. 

Dessert: Mashed prunes, baked apple or apple sauce. 

Supper (6:00 P. M.) : Cereal with warm milk or milk toast. 
Or plain custard or egg in some form. 
Or rice and apple baked together with berry 
juice. 



THE MOST FREQUENT 

COMPLAINTS 

AND DISEASES OF 

THE INFANT 



THE DISEASES OF THE INFANT 

Blennorrhoea 

This affliction results from infection of the baby's eyes 
at the time of birth and is the most dangerous of all 
the diseases which assail the new-born. Many infants 
have been rendered, through lack of care, absolutely blind. 
As soon as possible after birth, for the sake of precaution, 
the eyelids should be separated and each eye cleaned with 
separate pledgets of cotton and boric acid and a drop of 
5-10 per cent argyrol left between the lids. If, in the course 
of the next two days, it is noticed that the eyelids are 
swollen and that there is a discharge, a physician should be 
summoned, as the least delay is oftentimes disastrous. The 
disease begins in the second or third day after birth. In the 
beginning there is only swelling and redness of the lids and 
the lashes are stuck together. In the course of the next day 
the lids become more swollen and inflamed and a pus dis- 
charge appears between the lids. On the first appearance 
of pus a smear should be made for examination for gono- 
coccus; if it is positive, not a moment is to be lost. Ice water 
compresses must be applied to the affected eyes and 
changed every five minutes and the pus must be sponged 
away before it has time to collect. The infant should lie on 
the side of the affected eye and the sponging should be done 
away from it. It is a good plan to cover over the unaffected 
eye with isinglass. The nurse and the mother must use 
every precaution to keep their own eyes from becoming 
infected. The ice compresses have to be changed night and 
day every five minutes, and the pus should never be al- 
lowed to collect under the lids, as there is continuous 
danger of perforation of the cornea, and so loss of sight. 

ts 9 ] 



9<0 CARE AND FEEDING OF THE INFANT 

Scurf 

In many infants during the first months there is an in- 
crease in the production of the sebaceous glands, especially 
on the head. There results a brownish, yellow, fatty mass 
or collection of scales. This becomes mixed with dust and 
bacteria and ultimately has an unpleasant odor. This mass 
must be removed as soon as possible, which is accomplished 
by softening it with boric acid and vaseline or warm oil, 
applied best at night; the next morning the head is washed 
with warm water and soap and the hair combed with a fine- 
tooth comb. 

Intertrigo 

This is a light form of eczema which occurs mostly 
about the buttocks, between the legs, under the arms and 
about the neck. The skin becomes red, tender and moist 
and itches exceedingly. It results from the acidity of the 
urine or stools, from negligence and carelessness in not 
changing the diapers as often as necessary, and most fre- 
quently from diarrhoea or insufficient drying after the bath. 

It responds readily to cleanliness and frequent changes 
of diapers. Absolute dryness and treatment with boric acid 
and vaseline are all that are necessary. Often it is advisable 
to give bran baths. 

When more serious it is necessary to consult a physi- 
cian. 

Bednar's Aphthae 

Bednar's aphthae, named after the distinguished pedi- 
atrician of Vienna who first described the two symmetrical 
ulcerations on either side of the roof of the mouth over the 
hamular processes of the palate bone. These ulcerations 
seen in the new-born and very young infants are the result 
of traumaticism at the time of birth. The nurse in cleaning 
out the mouth exerts too much pressure over the external 



DISEASES OF THE INFANT 9I 

head of the pterygoid muscle, and the result is that the 
mucous membrane is abraded, and the bacteria on the 
ringer and in the mouth thus gain a foothold and an ulcera- 
tion results. 

This may be so painful that the infant refuses to nurse, 
or may attempt to do so and then give up, crying. Some- 
times it is accompanied by greenish stools. 

Usually it requires no treatment; when necessary it 
should be handled by a physician. Aqueous solution of 
boric acid and 5 per cent silver nitrate applied with an 
applicator are the best remedies. 

Thrush or Soor 

This is a parasitic growth on the mucous membrane of 
the mouth of the infant. It is really a fungus and looks like 
white irregular spots or curdled milk on the mucous mem- 
brane. It is generally located on the inside of the cheeks and 
on the tongue. 

It results from an abrasion of the mucous membrane — 
following clumsy handling — thus the fungus is able to 
obtain footing. Unclean nipples, breasts and fingers are a 
source of infection. 

It is sometimes accompanied by fever and intestinal 
disturbances and generally requires medical attention. 
The infants often refuse to nurse on account of pain. 

In the milder cases, applications of boric acid prove 
sufficient; in the more severe cases, more radical treatment 
under the advice of a physician should be inaugurated. 

Aphthous Stomatitis 

In this condition, small superficial yellowish ulcerations 
are found in the mucous membrane of the cheeks, gums and 
edges of the tongue. It is accompanied by fever, consider- 
able pain, salivation and green stools.- 



92 CARE AND FEEDING OF THE INFANT 

It requires constitutional handling, and the infant 
should be under the care of a physician. 

Colic 

Colic is due to disturbed intestinal conditions. Cold and 
chilling are predisposing factors. It occurs both with arti- 
ficially and breast-fed infants. With bottle-fed infants the 
more frequent causes are: Too much food; too frequent 
feedings; preparation given too cold; too quickly swallowed 
or percentage of fat or carbohydrate is too high. With 
breast-fed babies the following causes are noted: Errors in 
the mothers diet or the taking of cathartics; chemical 
changes in the milk brought about by chilling the breasts; 
weariness or mental upsets due to grief, joy, anger or 
fatigue. Habitual colic is often caused by cold feet, so the 
first thing to do for the relief of the baby is to see that the 
feet are warm, by wrapping them in a warm blanket or 
placing them against a hot-water bottle. By mouth, give 
two to three ounces of hot camomile or fennel tea. If the 
abdomen is distended, apply hot dry flannel cloths, or com- 
presses dipped in camomile tea; let the body lie on a hot- 
water bottle or rub the abdomen gently with warm olive 
oil; this starts the wind. If the colic still continues, give an 
enema of hot water or hot camomile tea or introduce a 
rubber catheter into the rectum to relieve the gas. If these 
measures are not successful, summon a physician. 

Convulsions 

On account of the inco-ordination of the nervous sys- 
tem, infants are predisposed to convulsions. Sometimes the 
first one occurs at the time of teething. They are often the 
prodrome, not only of diseases of the brain, but also of the 
lungs or intestines, and acute infectious diseases. They 
also occur with babies who are disposed to holding their 
breath. They require immediate preventive treatment, as 
the habit is said to predispose to epilepsy later in life. 



DISEASES OF THE INFANT 93 

The convulsion may begin with an extremity, about the 
mouth, the forehead or the eyes, and spread from there 
over the entire body. The infant becomes pale, uncon- 
scious, rolls the eyes backward, foams at the mouth, the 
lips become pale, the muscles of the face and the extremi- 
ties twitch, and the urine and stool may be evacuated. It 
lasts from a few minutes to hours. The longer the convul- 
sion lasts, the more dangerous it is to life, and it is neces- 
sary for the mother or nurse to accomplish as much as 
possible before the doctor arrives. 

The head of the infant should be kept high and covered 
with an ice-bag or cloths wrung out of ice-water. If the 
attack is a light one, rubbing the skin briskly with a wet 
crash towel until it is red, and giving a high, hot, colon 
irrigation, often prove sufficient. When more severe, the 
infant must be given a hot mustard pack and the feet put 
into a mustard bath. The pack is prepared by rolling the 
infant in large towels which have first been dipped in 
mustard water (two large tablespoonfuls of mustard to the 
quart of hot water). 

If the convulsions continue over a long time and the 
infant is becoming blue and the circulation shows evidence 
of failing, it should be given a hot mustard bath. The ears 
should be first stopped up with cotton before the infant is 
dipped in the water. In female infants a pledget of cotton 
should be inserted between the labia. The temperature of 
the water should be at least 103 F. and the nurse should 
test it with a thermometer. If this precaution is not taken, 
the infant is apt to be burned. 

A quick purge should be given and the food reduced to 
a minimum to ward off subsequent attacks. All further 
medication should be directed by the physician in charge. 

It is frequently necessary to administer chloral or some 
other hypnotic. Such remedies should only be used when 
necessary. 



94 CARE AND FEEDING OF THE INFANT 

Nasal Catarrh 

Catarrh of the nose is one of the most dangerous afflic- 
tions of infancy, and on this account any member of the 
family afflicted with a head cold should stay away from the 
baby, and above all should not kiss it. The mother while 
nursing should tie a handkerchief about her head and nose, 
as it is very infectious. Not only is catarrh unpleasant for 
the baby, but it interferes with nursing and spreads very 
easily to the respiratory passages, resulting in tonsillitis, 
bronchitis, pneumonia, or to the ears, resulting in ear dis- 
eases of one kind or another. As a precautionary measure, 
before the infant takes its outing, especially in raw weather, 
the nostrils should be lightly smeared with vaseline. In this 
way any bacteria which might be inhaled are impaled in 
the vaseline, which is removed when the infant returns to 
the house. 

If the running nose develops into a bloody discharge, it 
is suggestive of diphtheria or lues. If fever and a cough 
develop, a physician should be consulted. 

Earache 

From the beginning of infancy on, too careful attention 
cannot be directed toward the ears. Neglect of frequent 
attacks of inflammation often results in complete deafness. 
When the baby has an earache it cries out sharply, bores 
its head into the pillow, puts up its hands to the afflicted 
side and cries out whenever the ear is touched. It results 
frequently from a head cold, inflammation of the mouth 
(thrush or stomatitis), adenoids and inflammation of the 
throat. The least discharge from the ear requires the most 
careful treatment and should be under the care of a special- 
ist. After the morning bath the ears should be carefully 
dried out with cotton. 

The treatment consists in irrigation with a warm boric 
acid solution and the application of heat. The latter is best 



DISEASES OF THE INFANT 95 

applied with a small hot-water bottle or a bag filled with 
hot salt. xAll other medication should be left to the physi- 
cian. 

Constipation 

This is one of the most frequent complaints of infancy, 
and is due to over-feeding, under-feeding, heredity or some 
pathologic condition in the intestines. The cause must be 
very carefully gone into before treatment is begun. Most 
frequently it is due to errors in diet, and therefore it is a 
great mistake giving a physic, which relieves the condition 
without curing the cause. Until proper dietary regulation 
is begun, it is much safer giving an enema with hot water 
or one tablespoonful of sweet oil, or one-half or one teas- 
spoonful of glycerine in water, or a decoction of camomile 
tea, or soap and water solution or a suppository. The most 
satisfactory and safest treatment over any length of time is 
afforded by injections of hot water or camomile tea. Glycer- 
ine and soap enemas, when continued, are irritating to the 
bowel. 

One should always wait two days before resorting to an 
enema. The injection should be given with a bulb syringe 
which holds about two ounces. The tip should be of soft 
rubber so as not to irritate the rectum or injure the mucous 
membrane. It is a bad practice regulating the bowels with 
enemas and cathartics. They are best regulated in young 
babies by the diet. Increasing or substituting malt sugar 
or a malt preparation, if cane and milk sugar have been 
used, usually relieves the condition. In older children, 
orange juice, just before the morning bath, may be given; 
after six months a mixed diet consisting of one or two tea- 
spoonfuls of spinach or carrots puree and apple sauce may 
be added to the bill of fare. 

Also after six months one can begin training the baby 
by putting it on the stool regularly every morning at a cer- 
tain time, best just before the bath. The infant should be 



g6 CARE AND FEEDING OF THE INFANT 

encouraged at this time to have a passage; light massage of 
the abdomen twice a day stimulates peristalsis; at the 
same time a little sweet oil may be rubbed into the abdo- 
men. In massaging, one should begin in the right groin, then 
ascend to the ribs, cross to the other side and down to the 
left groin. This should be continued for five minutes or so. 
Or one may use deep massage, beginning in one groin and 
moving the fingers in a circle towards the umbilicus. 

Boiled, sterilized and pasteurized milk and an exclusive 
milk diet predispose to constipation. Too much fluid causes 
a distension, tires, and lessens the amount of work which 
the intestines can do; on this account the total amount 
of fluid ingested in twenty-four hours should be kept down. 

Croup 

Croup is a very alarming condition, especially as it may 
develop during the night without warning. Exposure to 
cold and wet are predisposing factors. During the day the 
nurse or mother may not have noted that the infant had a 
coryza and a slight temperature. During the night it may 
awaken showing signs of difficulty in breathing, with a 
hollow, dry, barking cough. The dyspnoea may be extreme; 
the baby sits upright, gasping for breath; the face becomes 
pale and bathed in perspiration, and the temperature may 
be elevated to 102 or 103 . 

Usually croup is spasmodic in nature and appears more 
alarming than it really is. It is usually not dangerous, but 
is apt to be repeated for three or four nights. One attack 
predisposes to others. 

If the attack is persistent and does not improve or 
grows worse, as the night wanes, one should think of diph- 
theria and a physician should be summoned. 

Treatment of Croup. — Keep the room warm. Apply 
counterirritants to the neck and chest; a mustard plaster 
best serves the purpose here (prepared by mixing with a 



DISEASES OF THE INFANT 97 

little water one tablespoonful of mustard and six table- 
spoonfuls of flour and spreading on cheesecloth; to avoid 
blistering grease neck and chest with vaseline before apply- 
ing poultice). Place the infant under a tent made over the 
crib, improvised by throwing a sheet over an opened um- 
brella; keep the tent filled with steam from a croup kettle, 
which should be saturated with turpentine or tincture ben- 
zoin. To relieve the laryngeal spasm induce emesis by ad- 
ministering twenty drops of the syrup of ipecac every two 
hours. If the symptoms are urgent, it is best to have a 
physician at hand, as it may be necessary to intubate. The 
attacks are frequently repeated for two or three successive 
nights. 

Vomiting and Diarrhoea 

As well as being the symptoms of a gastric and intesti- 
nal upset, both vomiting and diarrhoea are frequently the 
prodromata of some other disease, especially of one infec- 
tious in nature. 

The first thing to be done is to limit the amount of food 
and keep the infant quiet. If the symptoms are not par- 
ticularly severe, all solid food should be stopped and the 
milk freely diluted to reduce the fat, and no addition in the 
way of sugars should be made to the mixture. If the symp- 
toms are alarming, all food and milk should be stopped and 
boiled water or camomile tea given by mouth in small 
amounts every two or three hours. 

The second thing to do is to give a cathartic — calomel 
or castor oil — the dose being regulated according to the age 
of the infant. 

Crying 

The most frequent complaint to deal with in babies is 
crying, and no greater mistake can be made than to imag- 
ine that because a baby cries it is hungry, and therefore to 



98 CARE AND FEEDING OF THE INFANT 

give it more food without investigating further into the 
cause — there are many other causes than lack of food. 
Neither should the infant be taken out of bed, carried in 
one's arms or rocked to and fro. The thing to do is to 
investigate. 

The chief causes are as follows: 

A new-born baby cries because it longs for its mother; 
it wants to feel the warmth of her presence and snuggle 
close to her body. A hot-water bottle, comfortably near, 
pacifies the infant. 

Or it cries because it is hungry or over-fed. At first it is 
hard to get accustomed to the three-hour periods; when it 
comes to food most babies cry because they are over-fed 
and have colic. 

Or the infant is wet and has lain a long time in damp 
clothes and is uncomfortable, or the diapers or bands are 
too tight and the clothes are chafing, or the little buttocks 
and legs are sensitive and excoriated, or there is something 
foreign in the diapers, or it is too hot or too cold, a safety 
pin is sticking it or it is constipated and the bowels are full 
of hard stools which cannot be passed, the stomach is di- 
lated with gas, or a flea or other insect is biting it, or it is 
thirsty, or is at the beginning of an acute illness, or it is 
feverish, or has an earache and bores its head into the 
pillow and puts its hands to the ears, or there is a diastasis 
of the recti muscles, umbilical hernia, fissure in ano, or in 
male babies a too tight foreskin; or it may be a nervous 
baby and too much talking in the room, lights, and com- 
ing and going disturb it. 

Or the mother is a nervous, excitable woman and her 
condition only aggravates that of the infant. Often such a 
baby quiets down by putting it in charge of a calm, phleg- 
matic nurse and banishing the mother temporarily. 

More often these crying babies are over-fed and the 
omission of one feeding and the substitution of a bottle of 



DISEASES OF THE INFANT 99 

boiled water works wonders. Unless one is positive that it 
is hunger, it is a mistake to give more food or to feed more 
frequently. 

If the baby is constipated or the abdomen distended, 
the infant should be given an enema. However, the habit 
of giving enemas should not be started. The bowels should 
be regulated through the diet. 

If the infant is thirsty it immediately becomes quiet on 
giving it water or a weak solution of camomile tea. 

Often a warm bath and a bed warmed with a hot-water 
bottle subdues it, or if the crying is due to colic, placing it 
face down with a hot-water bottle under the abdomen, or 
rubbing the little stomach with warmed olive oil or placing 
hot, dry compresses soaked in camomile tea over the abdo- 
men, quiets and relieves it. 

Often one or two ounces of warm, sweetened fennel or 
camomile tea by mouth are comforting. Sometimes it is 
necessary to introduce a catheter into the rectum to relieve 
the gas. Under no circumstances should narcotics, sleeping 
potions or drugs be administered without the advice of a 
physician. 

If no reason is found for the restlessness, the infant 
should not be allowed to cry over too long a period; crying 
is work and requires strength, and by continuing it the 
baby becomes too tired to drink, does not gain in weight, 
and often diarrhoea results. 

Sometimes if the infant is a nervous one, it becomes 
quiet when it has a pacifier to suck on. When it continu- 
ously endeavors to suck on the finger, it is better to supply 
one. Under these circumstances it must be kept absolutely 
clean; before being given to the baby it should be washed 
with fresh water, and at least once a day boiled. Under no 
circumstances should a bone or pacifier made of cloth 
stuffed with bread or zwieback be given. 

Often a crying baby's attention can be distracted by a 
play-toy. 



TRAINING OF THE 
INFANT 



TRAINING OF THE INFANT 

Training begins with the birth of the infant. Many 
parents think it is not necessary to begin until the 
child is three or four years old and base their opinion on 
the fact that the small infant cannot reason, but the 
baby is impressionable and can appreciate cause and effect 
long before the intelligence is awakened. From birth on, the 
infant can be taught regularity, and after a few months 
obedience and cleanliness in habit. 

The first thing to inaugurate is absolute regularity, and 
this begins with the feeding periods. Many mothers give 
the baby the breast and later the bottle every time it cries. 
This is wrong. In the first place it is exceedingly bad for the 
digestion and in the second place the infant is not taught 
regularity. The feeding periods should be every three hours 
and it soon realizes this and awakens as regularly as a 
clock when the hour comes around. To get the infant into 
this habit, there being no reason to the contrary, it should 
be awakened at first regularly for its feedings, and it soon 
begins to regulate the naps by these periods; in this way 
the mother avoids the dangers of over-feeding and the in- 
fant is given its first lesson in temperance in eating. 

As soon as the baby is able to sit up it should be taught 
cleanly habits. One can begin with the fifth or sixth month. 
Most infants wet their diapers soon after their naps and 
after nursing. On this account it is a good practice to put 
them on the chamber as soon as possible after waking up 
and after feeding. Care must be exercised after nursing, as 
the food is easily regurgitated at this time. From the posi- 
tion, it soon begins to realize what is expected of it; a warm 
chamber accelerates urination and a cold one prevents it. 

By careful observation it is easy to tell when the infant 
is about to have a bowel movement. The face becomes 

[103] 



104 CARE AND FEEDING OF THE INFANT 

flushed; it makes straining movements and grunts. After 
these signs are noted, it should be put on the chamber. 
After a few weeks of this systematic training the infant will 
begin to make its desires known by a peculiar cry or by 
grunting. As soon as possible it should be trained to have 
its stool at a certain time every morning, preferably just 
before the bath, and it should be put on the chamber at the 
same time, whether it has a stool or not; this forming of a 
habit makes the greatest difference in the whole future de- 
velopment. While the infant is on the chamber it should be 
protected from drafts and under no circumstances should 
it be given anything to play with; toys at this time distract 
its attention, and everything should be done to bring about 
a sense of realization of its position. It should not be left 
too long on the chamber as the position predisposes to pro- 
lapse of the bowel. 

After the second year it should not wet the bed at night; 
this is best controlled by not giving the child any fluids after 
4 p. m. A semi-solid diet should be given at the usual sup- 
per hour. At about 10 p. m. the infant should be put on the 
chamber. It should also be induced to sleep on its side by 
making that position comfortable. A slight elevation of the 
foot of the bed is efficacious in keeping pressure off the 
neck of the bladder. If bed wetting continues after two and 
one-half years the urine and the genital organs should be 
examined for some source of irritation. 

The mother and nurse should not allow the infant to get 
into the habit of sucking a finger or thumb or a piece of 
blanket, nor give it a pacifier when it cries. The finger or 
finger nail is apt to become deformed by constant sucking 
and it has been claimed that malformations of the upper 
teeth have developed from such a practice. There is also 
constant danger of infection of the mouth, with thrush or 
stomatitis resulting. The constant sucking also stimu- 
lates the secretion of saliva, and disturbances of digestion 
result. 



TRAINING OF THE INFANT 105 

At all hazards the habit of sucking on the fingers or 
thumb should be broken. If necessary the infant should 
wear mittens, or the elbows should be put in splints so that 
it is impossible to get the hand to the mouth; or bands of 
adhesive plaster should be put around the favorite finger, 
or the nails should be painted with tincture of quinine. 

A normal baby does not require these means of pacifica- 
tion. However, if the infant is accustomed to a pacifier it is 
better to give it one than to allow it to suck continuously 
on the finger or to cry for hours. Continual crying and 
fretting results in loss of weight and intestinal disturbances 
and predisposes to hernia in one form or another. Under 
these circumstances the pacifier chosen should be one that 
can be kept absolutely clean. 

As before mentioned the infant should be kept in a room 
by itself with no loud talking or bright lights or other noise 
to disturb its rest. It should be so trained that it goes to 
sleep on being put in its cradle. The ultimate result de- 
pends on the beginning. It should not get into the habit of 
being rocked, walked or sung to sleep; sitting by the bed 
and holding one of the little hands is just as bad a habit. 
Further, every time it cries it does not require taking up or 
patting. Once this habit is begun it has to be continued. 
The nurse should see that the baby is dry and comfortable, 
and that is all that is necessary. 

The infant must also learn obedience. It is not neces- 
sary to wait until the third or fourth year. It should be 
made to realize the difference between the things it can do 
and can not, from the beginning. It should never be given 
playthings when it cries or whines for them. It should be 
made to understand that the desired object is refused be- 
cause it is naughty. Sometimes all that is required is an 
emphatic word or look. The infant soon comes to realize 
cause and effect. It is a bad practice to spank a little baby. 
As the infant grows older it should never be bribed into 



Io6 CARE AND FEEDING OF THE INFANT 

doing things. It should, from the beginning, be taught who 
is in authority. 

Playthings 

As everything given the baby ultimately reaches the 
mouth, this eventuality should be borne in mind in the 
selection of toys and the following things avoided: 

All articles artificially colored, as the dye is very fre- 
quently poisonous. 

All articles made of lead, as there is danger of poison- 
ing. 

All things covered with cloth; they become soaked in 
saliva and cannot be kept clean, and an infection of the 
mouth is apt to result. 

Toys covered with feathers, hair or fluffy material; 
pieces are apt to be swallowed, resulting in coughing or 
more serious complications. 

All toys with sharp corners or points, and all small arti- 
cles like rings, whistles, coins, etc. These articles are easily 
swallowed or poked into the ear or nose. 

The most suitable toys are made of rubber, bone or 
ivory. Very attractive rubber things can be bought in the 
shape of animals, dolls, etc. Celluloid articles are satisfac- 
tory providing they do not come in contact with fires, 
as they are explosive. 

One must be very careful about leaving thimbles, 
needles, tacks and pins around as they are easily picked 
up and swallowed. 

When an article is swallowed and the mother or nurse 
is confident that it has reached the stomach, the child 
should be fed bread crumbs, crusts or zwieback. These 
foods have a tendency to coat the article over with faecal 
material and prevent its injuring the susceptible mucous 
membrane lining of the intestine. Never should a cathartic 



TRAINING OF THE INFANT IO7 

be given, as it increases the fluidity of the intestinal con- 
tents, and the swallowed article, instead of being coated 
over with faecal material, sinks against the walls of the in- 
testine by virtue of its own weight and is not discharged. 
A cathartic also has a tendency to increase peristalsis, and 
so to injure the intestinal mucous membrane. 

Airing 

Fresh air is as necessary as fresh milk to a thriving 
baby. On this account it should be given an airing on every 
suitable day. In summer the new-born infant can be given 
its first outing after the first week — a calm sunny day 
should be chosen. In the spring, fall and winter it should 
not be taken out until it is three to four weeks old. For the 
first few times it should not stay out longer than one-half 
hour; gradually the time can be lengthened. The middle 
part of the day should be chosen, except in the heat of 
summer, when the house is the most appropriate place. It 
should never go out until one hour after the bath, until the 
early morning fog has cleared, and it should always be 
brought into the house as soon as the sun has gone down. 

On windy, rainy, snowy, foggy and very cold days it 
should remain indoors. 

All things considered it is better for the infant to be 
given its airing in the baby buggy rather than in the arms 
of the nurse. In the buggy it is protected from drafts and 
can be warmly covered. When the infant is carried it should 
be shifted from one arm to the other often, otherwise it is 
apt to develop a lordosis or become more proficient with 
one arm than the other. 



SPECIAL DIRECTIONS 



SPECIAL DIRECTIONS 
Enemas 

i. Camomile Tea: One teaspoon camomile leaves. Pour 
eight ounces of hot water over the leaves and allow to steep 
for three minutes. Strain through cheesecloth. Then it is 
ready for use. 

This makes the most satisfactory enema. It is non- 
irritating and soothing. 

2. Salt Solution: Six-tenths of one per cent. 

3. Glycerine: One teaspoonful glycerine to one ounce of 
water. Glycerine enemas are very good because it is not 
necessary to inject a large quantity of fluid. However, 
glycerine, when its use is continued, is irritating to the 
rectal mucous membrane. 

4. Soap-Water: Solution of warm water and a mild soap 
such as Castile. This is not one of the best to use as the 
soap is irritating to the bowel. It should never be used with 
young babies. 

5. Sweet or Olive Oil Enemas: Two tablespoon fuls olive oil 
to one and one-half ounces of warm water. This makes a 
good mild enema. One teaspoonful of olive oil alone may be 
injected with satisfactory results. 

6. Decoction Senna Leaves: One dessertspoonful to one 
quart of hot water. This makes a strong enema and usually 
gives a good result without irritation. 

Quantity 

Infant age one to two ounces. 

Child age three to eight ounces. 

[mi 



112 CARE AND FEEDING OF THE INFANT 

Position 

The child should lie on the right side with knees and 
thighs flexed while the tip of the syringe is inserted into the 
rectum. Or the child should lie on its back with the but- 
tocks elevated. Older children may assume the knee-chest 
position, that is, kneel upon the bed, resting the fore part 
of the body on the elbows. 

A rubber bulb syringe with a hard rubber tip about 
four or five inches long is the most satisfactory. 

The tip should be properly lubricated before being in- 
serted. 

After the enema has been injected the syringe should be 
quickly withdrawn and the buttocks pressed together to 
prevent the expulsion of the fluid. Sometimes it is necessary 
to repeat the injection before a satisfactory result is ob- 
tained. 



Temperature 



With an infant the temperature is best taken in the 
rectum. Groin, axillary and mouth temperatures prove less 
satisfactory. The quicksilver should be shaken below 98 
before the thermometer is inserted. One should see that 
the thermometer is absolutely clean, by cleansing it, first 
in a disinfecting solution and finally with alcohol. Then it 
should be lubricated with albolene or vaseline, and with 
the infant on the right side or back, with buttocks elevated, 
should be inserted for one-half or three-fourths of an inch. 
It should be then held in position one to two minutes, the 
infant being kept absolutely quiet to prevent any injury 
to the mucous membrane. A normal infantile temperature 
ranges between 98%° and ioo°. When it is below 98 ° the 
infant requires artificial heat. After the temperature is 
taken the thermometer should be cleaned in a disinfecting 
lotion and the quicksilver shaken down. 



SPECIAL DIRECTIONS 113 

High Enemas 

For use in acute catarrhal colitis and for removing 
poisonous and irritating excreta. 

The child should lie on the right side. A soft rubber 
catheter should then be introduced into the rectum and 
inserted as high as possible. The medicament, under gentle 
pressure, should be introduced through a funnel attached 
to the catheter. Then the funnel, catheter, etc., should be 
lowered so that the fluid may run off. This procedure 
should be repeated until the water runs clear. 

For this purpose hot normal salt solution, tannin 1%, 
1% liquor alumini acetatis, hot water or camomile tea 
should be used. 

Garlic Tea 

For removal of pinworms, make a decoction of garlic 
from a piece the size of a chestnut and sixteen ounces of 
water, boiling for one-half to one hour, straining and add- 
ing boiled water to make up for evaporation. This decoc- 
tion should be injected daily for two or three days. 

Poultices 

Mustard Plaster: One tablespoonful Coleman's mus- 
tard and six tablespoonfuls flour; mix in bowl with enough 
water to make a paste. Then take a doubled piece of cheese- 
cloth, large enough to cover the afflicted part, spread the 
mustard paste on it and cover with another piece of cheese- 
cloth. Then smear the skin lightly with vaseline to prevent 
blistering and apply the mustard plaster. It should be left 
in place until a good reaction is obtained, and then the skin 
lightly powdered with talcum. 

Cold Compress 

Take a piece of woolen or flannel cloth and cover it with 
a thin sheeting of oiled silk or rubber. Then a piece of gauze 



114 CARE AND FEEDING OF THE INFANT 

folded four thicknesses to the desired size is wrung out in 
lukewarm or cold water and placed upon it. The compress 
is folded about the afflicted part; the sheeting must be 
wider than the wet compress. It can be changed every 
half hour or remain longer in place. Unless the compress is 
properly applied it does more harm than good. 

Cold Pack 

A valuable means to reduce temperatures. 

Upon a hard surface, as a table, a woolen blanket is 
spread out. A sheet wrung out in cold water or water at 
room temperature is spread out upon the blanket and the 
naked infant placed in the middle of the sheet, which is 
then quickly folded about the child from chin to toes, and 
over it the woolen blanket is folded so that all the open 
spaces are closed up. The child should not be in this pack 
longer than ten to thirty minutes. 

The cold pack is successful only when, following the 
initial shock, the child feels well. The blood vessels dilate 
and the whole body becomes red. If the skin remains pale 
or blue, the child should be taken out and the pack not 
repeated. 

After the infant is taken out of the pack the skin should 
be thoroughly dried and the child laid in a warm bed. If 
there is a good reaction after the bath, it can be repeated 
many times. 

Flaxseed Poultice 

Take one ounce of flaxseed. (The meal cooks quicker 
than the seeds.) Add one pint of cold water and cook in a 
double boiler until a thick paste results. If the water evap- 
orates too quickly, add water until the proper consistency 
has been obtained. The seeds require a longer preparation. 
Then the paste is spread upon gauze or cheesecloth and, 
properly contained, folded about the part. Flaxseed 
poultices should be changed every half hour. 



SPECIAL DIRECTIONS 115 

Mustard Bath 

Three to five handfuls of freshly ground mustard flour 
are confined in as many bags of gauze, and added to two 
quarts of warm water, where they are heated, not boiled. 
Then this water, bags and all, is added to the bath and the 
infant is immersed and left until a good skin reaction is 
obtained. The ears of all babies and the vagina of girl 
babies must be protected with pledgets of cotton. 

Salt Baths 

One pound of Lurline or Carmel bath salts to the bath. 

Bran Bath 

Take one pound of white bran; sew it or tie it in a linen 
bag and cook for one-half hour. 

Then hang the bag in the bath and squeeze it. The bath 
is ready for use when the water is white and soft. 

Camomile Bath 

Take one-half pound of camomile leaves. Cook for ten 
minutes in two to three quarts of water. Strain through 
muslin. Add the camomile tea to the bath water and sus- 
pend the leaves tied in a muslin bag in the bath tub. 



RECIPES 



RECIPES 

Whey: To one pint of whole milk warmed to 40 C. add two 
teaspoonfuls Fairchild's essence of pepsin or liquid rennet 
and a pinch of salt. Allow to stand for one-half hour in a 
warm place until coagulation has taken place. The curd 
should then be broken up with a fork and the whey strained 
ofT through a muslin bag. 

Junket: If it is desired to preserve the curd alone, it is not 
necessary to break it up, but the whey should be strained 
off. Junket makes a good dish for children from twenty 
months on, or earlier if necessary to give more solid food. 

Buttermilk: Strain a quart of buttermilk (not older than 
twenty-four hours) through a fine sieve. Of this take six to 
seven ounces; add one and one-half level tablespoonfuls of 
flour and mix thoroughly together; then add the rest of the 
quart of buttermilk and heat the whole mixture for one- 
half hour, stirring constantly. Allow it to boil up three 
times for just a second, removing it each time quickly from 
the fire, just as soon as it boils up. Before the final boiling 
up, five level tablespoonfuls of sugar — cane or other sugar 
— should be added to the mixture. The preparation is now 
ready for division into the required number of bottles. 

Oatmeal Water — Barley Water: To one pint of water add 
one level tablespoon of Quaker oats or barley flour. Boil 
in a double boiler for one hour. At the end of that time add 
boiled water to make up for what has evaporated, and 
strain through a muslin cloth. To be used for diluting pur- 
poses after the third month. 

Malt Soup: The original malt soup of Keller is prepared as 
follows (there are many modifications of this preparation) : 
Mix fifty grams of flour in one-third of a quart of milk. 
Slightly warming accelerates the mixing . After it is thor- 
oughly mixed put it through a sieve. 

1 119] 



120 CARE AND FEEDING OF THE INFANT 

In another porcelain dish mix one hundred grams of 
LoefHund's malt soup extract with two-thirds of a quart 
of water. Then this should be heated almost to the boiling 
point, until the malt goes into solution. Then both prepar- 
ations should be poured into one porcelain dish and the 
whole mixture brought three times to a boil. Malt soup 
should never be used except on the recommendation of a 
physician. 

Eiweiss Milk or Proteid Milk: The first step in the prepara- 
tion of eiweiss milk is the same as in the preparation of 
junket and whey, with this exception — the whey is thrown 
away and the curd, after being placed in a muslin bag, is 
washed in tap water to get rid of as much of the whey as 
possible. Then it is mixed with one pint of boiled water and 
with a spoon forced twice through a hair sieve in order to 
break up all clumping. Then one pint of buttermilk is 
added and the mixture is ready to be divided into the bot- 
tles and sterilized. 

Liebigs Soup: ioo grams malt flour or peeled malt, ioo 
grams flour, 10 grams 11% solution of potassium carbon- 
ate are mixed in a porcelain cooking dish. To this mixture 
one quart of milk is added and the whole preparation 
cooked over a slow fire to 6o° or 70 C. Just as soon as it 
cooks thick it should be taken off the fire and stirred vigor- 
ously for five minutes. Then it should be put on the fire 
again until it is thick, and stirred thin. For the third and 
last time it should be allowed to boil up and then be 
strained. 

Gruel: To twelve ounces of whole milk add one and one- 
half to two level tablespoonsfuls wheat flour, rice flour or 
Scotch oatmeal. Stir constantly for fifteen or twenty min- 
utes over a medium fire, until thick. Add salt and one-half 
teaspoonful sugar. If desired, serve with fruit juices. 

Zwieback Gruel: Powder several pieces of zwieback with a 



RECIPES 121 

rolling pin. Of the powder take two level tablespoonfuls and 
add it to ten ounces of whole milk in a porcelain cooking 
dish. Cook for fifteen to twenty minutes, stirring con- 
stantly. Add one-half teaspoonful butter and a pinch of 
salt. 

SOUPS 

Mutton, Veal Broth or Beef Broth: Take eight ounces of beef 
or veal or shoulder of mutton. Add four ounces of chopped- 
up bone, preferably near the joint, a carrot and some soup 
greens and a quart and one-half of cold water and one- 
fourth teaspoon salt. Cook for two to three hours in a cov- 
ered kettle until six or eight ounces of broth remain. Strain 
through a hair sieve and skim off the fat. This makes a 
strong broth, which may be diluted if desired. 

Additions may be made to this soup in the way of well- 
cooked rice, barley, arrowroot or farina, which increases its 
nutritional value. 

After the child is eighteen months old, the yolk of an 
egg stirred into six ounces of the soup and cooked for two 
to three minutes makes a nutritious addition and at the 
same time accustoms the child to taking eggs. 

Chicken Broth: Take one-half a chicken or one-half of an 
old pigeon. Cut it up into parts or pass through a meat 
grinder. Add one quart of cold water and soup greens and 
cook for an hour down to six or seven ounces. A little well- 
cooked rice or barley may be added to this. Instead of 
water, veal or beef broth may be used. 

Beef Tea: Take eight ounces of raw, fat-free beef. Cut into 
fine pieces and put into a pint fruit jar without the least 
water. Screw the cover on tight; then put the jar in a kettle 
of cold water, so that it is two-thirds covered, and let it boil 
for three or four hours. When necessary to replenish the 
water, only hot water should be used. Afterwards the beef 
juice should be pressed out through a piece of cheesecloth 



122 CARE AND FEEDING OF THE INFANT 

or muslin. A small wine glass of beef juice is thus obtained. 
A pinch of salt should be added to it, and, because it spoils 
very easily, it should be kept on ice. It can be served cold. 
It should be heated only in a warm bath, and then but 
slightly. The least cooking results in flakes of meat. 

Tomato Soup: Take a pound of tomatoes and cover them in 
a pot with cold water; allow them to stew slowly. Then, to- 
gether with the water in which they have cooked, they 
should be put through a sieve. One-fourth of a teaspoonful 
of melted butter and salt and sugar to taste should be 
added. Instead of water, broth may be used. 

Beef Juice: Take eight ounces of lean beef. Broil for a 
second on each side. Cut into squares and extract the 
juice in a meat press or lemon squeezer. The juice should be 
collected in a small wine glass and a pinch of salt added. 
If the meat is not first broiled, it is not nearly so palatable 
or delicious. When ready for use it should be heated in a 
water bath, never directly, as pieces of meat are apt to 
form. 

Beef Juice: Cut eight ounces of previously lightly broiled 
beefsteak into small squares and collect them in a muslin 
bag. Immerse the bag containing the squares of beef in 
about three ounces of cold water. Allow to stand for three 
hours and express the juice by pressure. Beef juice by this 
method is not nearly so strong as those previously de- 
scribed. 

Farina and Milk: Farina one ounce, milk seven ounces. 
Mix and cook over a slow fire for one hour, being careful 
that the preparation does not burn; stir constantly with a 
wooden spoon; add salt or sugar to taste and serve with 
fruit juices. 

Cereal Jelly: Of pearl barley, oatmeal or rice, four level 
tablespoonfuls; soak in water for ten to twelve hours. 
Then add to one quart of fresh water and boil in a double 



RECIPES 123 

boiler for at least four hours. Cook until boiled down to one 
pint. Strain and allow to cool. The jelly which now forms 
makes a nutritious addition to milk. 

Oat Gruel: Take one ounce of rolled oats and cook thor- 
oughly in eight ounces of water. Strain and add four ounces 
of milk, stirring continuously with a wooden spoon and 
cooking until thick. Add one-fourth teaspoon butter and 
salt to taste. 

Gruel from Wheat or Corn Flour: Take one level tablespoon- 
ful of wheat or corn or rice oatmeal flour — add eight 
ounces of whole milk. Stir continuously for one-half hour 
and cook over medium fire. Add salt and one-fourth tea- 
spoon butter as desired. 

Milk Rice: Take one and one-half ounces of rice — wash it 
thoroughly in cold water. Add twelve ounces of milk and 
one level tablespoonful sugar. Cook steadily for one to one 
and one-half hours, stirring frequently. 

Apple Rice: One-half pound apples — peeled, cored and cut. 
Add one tablespoonful of sugar and a little lemon peel. 
Stew quickly in a little water. 

Three ounces of rice thoroughly cooked in one pint of 
water. When the rice is thoroughly cooked, add the apples 
to it. 

Apple Rice: Two ounces of rice are cooked for one hour in 
eight to ten ounces of milk. One-fourth pound of apples — 
peeled, cut and stewed soft in a little water with a table- 
spoonful sugar and a little butter. 

As soon as the rice has cooled, one ^gg y one-half tea- 
spoon butter and one tablespoonful of sugar and a teaspoon 
of lemon juice are added and the whole mixture thoroughly 
stirred. Then a porcelain cooking dish is smeared with 
butter. 

First a layer of the rice mixture is spread in the porce- 
lain dish, then a layer of the apple and finally the rest of 



124 CARE AND FEEDING OF THE INFANT 

the rice. It is put in the oven and baked for twenty to thirty 
minutes. 

Oatmeal Souffle: Take four tablespoons oatmeal flakes; add 
eight ounces of milk. Cook to the consistency of a gruel and 
then allow it to become cold. Mix thoroughly together one 
ounce, by weight, of butter and one and one-half table- 
spoonfuls of sugar and the yolks of two eggs. The whites 
are beaten and mixed with the oatmeal gruel and then with 
the butter, sugar and yolk of egg mixture. The whole thing 
is then baked in a porcelain dish for one-half hour. 

Egg Souffle: Three level tablespoonfuls flour, seven ounces 
of whole milk and one-half ounce, by weight, of butter are 
cooked to the consistency of gruel, stirring constantly, and 
allowed to cool. Then little by little the yolks of two eggs 
and a little grated lemon or orange peel are added by way 
of seasoning, and gradually the beaten whites of two eggs 
are added. It is then cooked in a porcelain dish which has 
been previously smeared with butter. 

Sago Souffle: Five level tablespoons of clean white sago are 
cooked in one pint of milk, stirring constantly to prevent 
burning, until soft. Then after it is thoroughly cooked it is 
allowed to grow cold in a porcelain dish. One ounce of but- 
ter is beaten in, the yolks of two eggs added, and sugar and 
salt according to taste. At the conclusion the beaten whites 
of two eggs are added. Then it is baked for three-fourths of 
an hour in a medium hot oven, in a form previously 
smeared with butter. 

Lemon Souffle: The yolks of two eggs and one teaspoonful 
of sugar are thoroughly mixed together. Then the juice of 
one-half a lemon and a little grated lemon peel are added 
and for ten minutes thoroughly mixed. Finally a teaspoon 
of flour and the beaten whites of two eggs are stirred in. 
The whole mixture is baked for ten minutes in a porcelain 
cooking dish smeared with butter. 



RECIPES 125 

Apple Souffle: One pound of apples — peeled, cut and with 
two tablespoonfuls sugar placed in a porcelain dish. 

A gruel is made from one ounce of butter, three table- 
spoonfuls of sugar, the yolks of two eggs and three level 
tablespoonfuls of flour, four ounces of milk and the beaten 
whites of two eggs stirred in. This mixture is poured over 
the apples in the porcelain dish and baked for one hour in 
the oven. 

Vegetables 

Spinach: Take one-half pound of young spinach. Wash it 
in cold water. Then cook it for thirty minutes in a pint of 
water after adding a pinch of salt. The young leaves cook 
much quicker than the old ones. As soon as the spinach is 
thoroughly cooked, the water is drained ofT and the leaves 
chopped up as fine as possible. During this process the 
water in which the spinach has cooked is boiled down so 
as to preserve all the extractives, and added to the leaves 
again. A little butter is now added and the whole mixture 
is put through a sieve. The spinach may also be cooked in 
milk. 

Lettuce may be prepared in the same way. 

Carrots: Six ounces of carrots, without the greens, are 
washed, peeled and cut in disks and cooked slowly in a pint 
of water with one-fourth teaspoon salt for three-fourths of 
an hour. The water is drained off and boiled down to a 
small volume; one-half teaspoon butter and a little salt are 
added and the mixture pressed through a hair sieve. 

Instead of cooking the spinach and carrots in water, it 
may be accomplished in milk. Then it is not necessary to 
add butter. 

Potato Puree: Clean and peel eight ounces of mealy 
potatoes and cook in salt water (one-half teaspoon salt to 
a quart of water) for one-half hour. Drain off the water and 



126 CARE AND FEEDING OF THE INFANT 

dry out somewhat in the oven. Put them through a sieve; 
add one-half teaspoon of butter and four ounces of milk and 
mix thoroughly. 

Puree of Green Peas: Take one-half pound of fresh green 
peas. Add five ounces of cold water or whole milk, one- 
fourth teaspoon salt, and cook thoroughly for one hour. 
When cooked down put through a hair sieve. 

Cauliflower: Scald a small head of cauliflower. Wash it 
thoroughly in cold water. Remove the blooms and discard 
the stalk (as it is indigestible to an infant). Add eight 
ounces of milk or eight ounces of water. Cook thoroughly; 
add salt and butter to taste and put through a sieve. 

Fruit 

Juices of fresh berries, grapes or oranges. Extract the 
juices in a lemon squeezer or fruit press. Remove the seeds 
and administer in a teaspoon. If sour sweeten with 
saccharin. 

Apple and Pear Sauce: Wash, peel, core and quarter — 
eight ounces of apples or pears. Add four ounces of water 
and cook thoroughly in a stew pan. Add two tablespoon- 
fuls sugar and strain. 

Mashed Prunes: Take eight ounces of prunes. Cook thor- 
oughly. Remove stones. Scrape meat free and put through 
a hair sieve. 

Banana Souffle: Take two bananas. Peel and cut into disks. 
Add eight ounces of milk and one-fourth teaspoon salt. 
Bake for fifteen minutes and strain. 



INDEX 



INDEX 



Adenoids in speech, 21 
Airing, 107 

Albumen urine at birth, 8 
Aphthae, Bednar's, 90 
Artificial feeding, 71 
Artificial respiration, 46 
Asphyxia: Treatment, 45 

Baby buggy, 40 

Barley water, 119 

Baths: Duration infant, 29; 
first for infant, 26, 27, 28; 
temperature for infant, 
27, 28, 29; maternal dur- 
ing pregnancy, 4; medici- 
nal bran, 115; medicinal 
camomile, 115; medicinal 
mustard, 115; medicinal 
salt, 115 

Bed, the, 33 

Bednar's aphthae, 90 

Beef tea, 121 

Beef juice, 122 

Blennorrhcea — inflamma- 
tion eyes, 89 

Bloody nasal discharge, 94 

Bones at birth, 17 

Bottles, 75 

Bowlegs at birth, 17 

Bowlegs and diapers, 38 

Breasts : Care of during preg- 
nancy, 4; care of follow- 
ing birth, 55 ; injury to, 64; 
milk in new-born, 11 



Broths, 121 
Buttermilk, 119 

Cane sugar, 82 

Caput succedaneum, 10 

Carrying, 42 

Catarrh of the nose, 94 

Cephalhematoma, 11 

Cereals, 122 

Cleft palate, 10, 54 

Clothes during pregnancy, 3 

Clothes: Infant, 3$, 36; 

night, infant, 40 
Cold pack, 114 
Colds, frequent, 35 
Colestrum, 57 
Colic, 35, 92 
Compresses, cold, 113 
Condensed milk, 82 
Constipation, 95 
Convulsions, 92 
Cord, care of, 25, 26 
Croup, 96 
Crying, 35, 83, 97 

Dentition: First set, 18; 
Pfaundler's rule, 18; de- 
layed, 18; early symp- 
toms of, 19 

Diapers, the, 37; changing 
of, 39; soiled, 39 

Diarrhoea, 3$, 97 

Diet during pregnancy, 3; 
diet nursing mother, 54 

[129] 



I30 INDEX 

Diets, 84, 85, 86 

Diphtheria, 94 

Drugs excreted in milk, 55 

Earache, 94 
Ears, care of, 30, 43 
Eiweiss milk, 120 
Enemas, directions for giv- 
ing, 1 1 1 , 1 1 2 ; in constipa- 
tion, 95 
Epilepsy and nursing, 52 
Excitement on nursing, 54 
Exercise, while pregnant, 3 
Eyes : Care of following birth 
25,27, 29; incoordination 
of new-born, 20; inflam- 
mation of new-born, 12, 
89; new-born, 10 

Feeding: Artificial, 71; 

management of, 76, 83, 

84; breast management 

of, 59, 60, 61 ; breast baby 

after six months, 66, 67; 

breast baby, schedules 

for, 61, 66, 69; mixed, 

69,70 
Finger sucking, 104 
Fissures, breast, 64 
Fontanelles: Anterior and 

posterior, 7; closure of, 17; 

n ric kets,myxcedema, 

17; cretinism and 

hydrocephalus, 17 
Food, artificial, preparation 

of, 78 



Formulas, artificial food, 80 
Fruit, 126 

Garlic tea, 113 

Genitalia, female, in bath- 
ing, 27,40, 115 

Gonorrhceal infection of 
eyes, 89 

Gruel, 120 

Hair, 7 

Hairlip, 10, 54 

Head: Change of position 
in bed, 33; circumference 
at birth, 7; circumference 
one year, 17; following 
birth, 17 

Hiccoughing, 3 s 

Hydrocephalus, fontanelle 
in, 17 

Hysteria and nursing, 52 

Icterus of the new-born, 11 
Incoordination new-born, 

9; incoordination eyes 

new-born, 20 
Incubators, 44; benefits of, 

44 

Infectious diseases and nurs- 
ing, 5 2 

Intertrigo, 90 

Jaundice at birth, 11 
Junket, 119 

Kissing, 41 



Lactose, milk sugar, 82 

Lanugo, 7, 1 1 

Length: New-born, 7, 17; 

infant at six months, 17; 

infant at one year, 17 
Liebig's soup, 120 
Lifting, 42 
Lues, 94 
LoeffluncTs malt soup, 120 



Malt soup, 119 
Maltose, malt sugar, 82 
Massage in constipation, 96 
Measurements, new-born, 

7, 16 
Meconium, 8 
Menstruation and nursing, 

52 
Milk: Care of, 72; changes 
due to boiling, 73; drugs 
excreted in, 55; pasteur- 
izing of, 75; requirements 
of, 72; sterilizing of, 74; 
breast, sufficient quantity 
of, 63; breast, too little, 
63; breast, too much, 63; 
fever, 57; first appearance 
in breasts, 56; sugar, lac- 
tose, 82 
Mouth, care of, 27, 30 
Muscular development, 18 
Myxcedema, fontanelle in, 
17 

Nails, care of, 30 



INDEX 131 

Nasal catarrh, 94 

Navel, 25, 26, 27, 28; infec- 
tion of, 28 

Nervous child, 32 

Nipples, breast, sore, 64 

Nipples, rubber, 75 

Nursery, the, 31; airing of, 
3 1 ; furnishing of, 3 1 ; tem- 
perature of, 31 

Nursing: Contraindications 
to, 51; difficulties in, 53; 
mother, care of, 54; pe- 
riod, duration of, 60; the 
first, 56, 58, 59 

Oatmeal water, 119 

Pacifier, the, 82 

Pasteurizing milk, 75 

Pharyngitis, 19 

Pinworms, 113 

Playthings, 106 

Poultices, 113, 114 

Pregnancy and nursing, 53 

Premature baby: Care of, 
43; feeding of, 44, 62; 
signs of, 7 

Prepared foods, 82 

Proteid milk, 120 

Pulse: At birth, 8; in in- 
fancy, 8 

Recipes, 119 
Recognition, etc., 20 
Regurgitation, 34, 39 



132 



INDEX 



Respiration: New-born, 8; 

in infancy, 8 
Rickets: Dentition in, 19; 

early signs of, 17; fonta- 

nelle in, 17; prepared 

foods, 82 

Scurf, 90 

Sight : At birth, 20; develop- 
ment of, 20 

Sleep: New-born, 9, 21, 27; 
position during, 10; re- 
quirements for, 33 

Smile, first , 20 

Soor, 91 

Souffle, 124 

Soups, 121 

Special senses, new-born, 
10, 19 

Speech, 21; delay in, 21 

Sponge bath, 26, 27 

Squint eyes, new-born, 20, 

41 \ 
Sterilization of milk, 74 
Stomach, new-born, 9 
Stomatitis, 19, 94, 104 
Stomatitis, aphthous, 91 
Stools at birth, 8 

Teeth: Care of, 30; order of 
appearance, 18 

Temperature, 9; bath, 26; 
nursery, 27; subnormal, 
43; taking of, 9, 112 

Thrush, 19, 30, 91, 94, 104 



Tonsillitis, 19 
Tonsils and speech, 21 
Training, 103 
Tuberculosis, 51 

Uric acid, in new-born, 8 
Urine, of new-born, 8 

Vagina: Bloody discharge in 
new-born, 12; care of fol- 
lowing birth, 25; care of, 
30,40, 115 
Vegetables, .125 
Vernix caseosa, 25, 26 
Vomiting: Tight clothes, 
3$; treatment of, 97 

Walking, 18 

Water, bath, temperature, 

27 
Weak infants: Care of, 43, 

53; feeding of, 44 
Weaning, 67 
Weighing, 42 
Weighing bottle-fed baby, 

Weight: During infancy, 16; 
gain per week, 16; loss 
following birth, 15; new- 
born, 7, 15 

Wet-nurse: Examination of, 
6$; requirements of, 65 

Whey, 119 

Zwieback gruel, 120 



